Healthcare Provider Details

I. General information

NPI: 1730416678
Provider Name (Legal Business Name): VIRGINIA CLAIRE KOLVITES DPT, PCS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2009
Last Update Date: 08/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 PINEHILLS DR
HATTIESBURG MS
39402-3317
US

IV. Provider business mailing address

135 PINEHILLS DR
HATTIESBURG MS
39402-3317
US

V. Phone/Fax

Practice location:
  • Phone: 864-293-3281
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number12760
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number12760
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number12760
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number12760
License Number StateNC
# 5
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPT-6066
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: