Healthcare Provider Details

I. General information

NPI: 1891616512
Provider Name (Legal Business Name): JENNIFER MICHELLE KOLAR PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 EDMONDS ST
EDMONDS WA
98020-5094
US

IV. Provider business mailing address

311 EDMONDS ST
EDMONDS WA
98020-5094
US

V. Phone/Fax

Practice location:
  • Phone: 425-200-4421
  • Fax: 855-595-1125
Mailing address:
  • Phone: 425-200-4421
  • Fax: 855-595-1125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT.PT.70131313
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: