MEDICARE: MR. KARL JAMES KOLBECK PT

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	2675	OR
2	225100000X	Physical Therapist	4199	WI
3	225100000X	Physical Therapist	PT00005973	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720066780
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KARL JAMES KOLBECK PT

Provider Business Mailing Address
First Line	:	25 NW 23RD PL
Second Line	:	STE 6 - 311
City	:	PORTLAND
State	:	OR
Zip	:	97210-5580
Country	:	US
Telephone Number	:	503-913-4450
Fax Number	:	866-866-1976

Provider Business Practice Location Address
First Line	:	1515 NW 18TH AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97209-2516
Country	:	US
Telephone Number	:	503-228-1306
Fax Number	:	503-228-1307

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

Provider Enumeration Date	:	01/09/2006
Last Update Date	:	06/18/2012

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