Individual
MARK KOLB
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
1525 HERBERT ST STE 103, PORT ORANGE, FL 32129-6107
(386) 756-0424
(386) 756-0425
Mailing address
3453 COUNTRY WALK DR, PORT ORANGE, FL 32129-3156
(386) 299-7427
(386) 756-0425
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA 20708
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PTA 20708
PHYSICAL THERAPIST ASSIST
FL
Enumeration date
02/06/2007
Last updated
07/08/2007
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