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General NPI Number Information
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NPI Number | 1760084883
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Entity Type | Individual
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Provider Name | MELISSA J KOLAZYK PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 11/13/2020
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Last Update Date | 11/13/2020
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Provider Practice Location Address
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Address Line | 1290 WELLBROOK CIR NE
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City | CONYERS
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State | GA
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Zip | 30012-8031
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Country | US
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Telephone | 770-918-3870
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Fax |
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Provider Business Mailing Address
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Address Line | 471 GLENWOOD PL SE
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City | ATLANTA
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State | GA
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Zip | 30316-1819
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Country | US
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Telephone |
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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 | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | PT013608
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License Number State | GA
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