Healthcare Provider Details

I. General information

NPI: 1073251765
Provider Name (Legal Business Name): MARIIA KOLESNIKOVA PTA,LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2022
Last Update Date: 01/07/2025
Certification Date: 01/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1235 LAKE PLAZA DR STE 221
COLORADO SPRINGS CO
80906-3556
US

IV. Provider business mailing address

3923 BERKLEY CT
COLORADO SPRINGS CO
80906-6371
US

V. Phone/Fax

Practice location:
  • Phone: 719-271-9663
  • Fax:
Mailing address:
  • Phone: 302-864-7067
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA.0015169
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number0026233
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: