Healthcare Provider Details

I. General information

NPI: 1588329569
Provider Name (Legal Business Name): OLGA KOLENBERG PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2021
Last Update Date: 12/09/2024
Certification Date: 12/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 E PUTNAM AVE STE 14
COS COB CT
06807-2753
US

IV. Provider business mailing address

11 BERTMOR DR
STAMFORD CT
06905-2114
US

V. Phone/Fax

Practice location:
  • Phone: 203-512-4149
  • Fax: 203-358-0052
Mailing address:
  • Phone: 203-512-4149
  • Fax: 203-990-3393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number006882
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code2081P0010X
TaxonomyPediatric Rehabilitation Medicine Physician
License Number006882
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number006882
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: