Provider Demographics
NPI:1073251765
Name:KOLESNIKOVA, MARIIA (PTA,LMT)
Entity type:Individual
Prefix:
First Name:MARIIA
Middle Name:
Last Name:KOLESNIKOVA
Suffix:
Gender:F
Credentials:PTA,LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3923 BERKLEY CT
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-6371
Mailing Address - Country:US
Mailing Address - Phone:302-864-7067
Mailing Address - Fax:
Practice Address - Street 1:1235 LAKE PLAZA DR STE 221
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-3556
Practice Address - Country:US
Practice Address - Phone:719-271-9663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-24
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0026233225700000X
COPTA.0015169225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COPTA.0015169OtherCOLORADO DIVISION OF PROFESSIONS AND REGULATIONS