Healthcare Provider Details

I. General information

NPI: 1245986322
Provider Name (Legal Business Name): ABIGAIL LOUISE KOLACZ PT, DPT, LAT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2022
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 HENNEPIN AVE
MINNEAPOLIS MN
55403-1816
US

IV. Provider business mailing address

8765 PRESTWICK PKWY N
BROOKLYN PARK MN
55443-3909
US

V. Phone/Fax

Practice location:
  • Phone: 612-313-0520
  • Fax:
Mailing address:
  • Phone: 763-227-6885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number3825
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number14386
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: