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General NPI Number Information
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NPI Number | 1215183223
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Entity Type | Organization
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Legal Business Name | KOLB CORPORATION
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Dates
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Enumeration Date | 08/10/2008
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Last Update Date | 08/10/2008
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Provider Practice Location Address
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Address Line | 481 PENBROOKE DR SUITE 5
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City | PENFIELD
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State | NY
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Zip | 14526-2044
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Country | US
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Telephone | 585-678-4713
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Fax | 585-678-4713
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Provider Business Mailing Address
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Address Line | 481 PENBROOKE DR SUITE 5
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City | PENFIELD
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State | NY
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Zip | 14526-2044
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Country | US
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Telephone | 585-678-4713
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Fax | 585-678-4713
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Authorized Official
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Title or Position | PRESIDENT
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Name | VIKKI KOLB
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Credential | LMT
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Telephone | 585-678-4713
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 011919
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License Number State | NY
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