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General NPI Number Information
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NPI Number | 1396786513
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Entity Type | Individual
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Provider Name | VIKKI KOLB LMT
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Gender | Female
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Dates
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Enumeration Date | 06/09/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 2060 FAIRPORT NINE MILE PT RD SUITE 403
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City | PENFIELD
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State | NY
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Zip | 14526-1749
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Country | US
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Telephone | 585-261-8105
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Fax |
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Provider Business Mailing Address
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Address Line | 2060 FAIRPORT NINE MILE PT RD SUITE 403
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City | PENFIELD
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State | NY
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Zip | 14526-1749
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Country | US
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Telephone | 585-261-8105
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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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