Individual
MS. LISA MARGARET KOLESAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT, ACT/L
Contact information
Practice address
7979 W RIFLEMAN ST STE 100, BOISE, ID 83704-9066
(208) 377-3850
(208) 658-1360
Mailing address
2101 S PHILLIPPI ST, BOISE, ID 83705-3646
(208) 866-7428
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1988
ID
2255A2300X
Athletic Trainer
234
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010142952
BLUE SHIELD OF IDAHO
ID
05
—
805753950
—
ID
01
—
TD492
BLUE CROSS OF IDAHO
ID
Enumeration date
04/26/2006
Last updated
12/13/2011
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