Healthcare Provider Details

I. General information

NPI: 1578159307
Provider Name (Legal Business Name): REBECCA TAYLOR KOLB PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REBECCA TAYLOR CANNIZZARO

II. Dates (important events)

Enumeration Date: 12/16/2020
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3708 FORESTVIEW RD STE 101
RALEIGH NC
27612-2391
US

IV. Provider business mailing address

2122 YORK RD STE 300
OAK BROOK IL
60523-1925
US

V. Phone/Fax

Practice location:
  • Phone: 919-786-7434
  • Fax:
Mailing address:
  • Phone: 570-550-0168
  • Fax: 410-648-4878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP054490T
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT029014
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: