Healthcare Provider Details

I. General information

NPI: 1659505261
Provider Name (Legal Business Name): KIMBERLY JOSEPHINE COLER LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2009
Last Update Date: 05/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 COMPUTER DR W SUITE 111
ALBANY NY
12205-1616
US

IV. Provider business mailing address

18 COMPUTER DR W SUITE 111
ALBANY NY
12205-1616
US

V. Phone/Fax

Practice location:
  • Phone: 518-573-7252
  • Fax: 518-477-2421
Mailing address:
  • Phone: 518-573-7252
  • Fax: 518-477-2421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number017468
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: