MEDICARE: JOHN KOLAR P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	JK010409	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0B35703	OTHER	MI	BCBS OF MICHIGAN
2	P25179F	OTHER	MI	BLUE CARE NETWORK MI

General Provider Information

NPI Number	:	1184625576
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN KOLAR P.T.

Provider Business Mailing Address
First Line	:	416 S CREYTS RD
Second Line	:	SUITE B
City	:	LANSING
State	:	MI
Zip	:	48917-8290
Country	:	US
Telephone Number	:	517-327-0966
Fax Number	:	517-327-0986

Provider Business Practice Location Address
First Line	:	416 S CREYTS RD
Second Line	:	SUITE B
City	:	LANSING
State	:	MI
Zip	:	48917-8290
Country	:	US
Telephone Number	:	517-327-0966
Fax Number	:	517-327-0986

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	07/08/2007

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