Provider Demographics
NPI:1093353872
Name:KOLODZIEJ, THERESA (PT)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:KOLODZIEJ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81B FOXBERRY DR
Mailing Address - Street 2:
Mailing Address - City:GETZVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14068-1049
Mailing Address - Country:US
Mailing Address - Phone:716-472-5356
Mailing Address - Fax:
Practice Address - Street 1:1503 MILITARY RD
Practice Address - Street 2:
Practice Address - City:KENMORE
Practice Address - State:NY
Practice Address - Zip Code:14217-1339
Practice Address - Country:US
Practice Address - Phone:716-447-6506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-12
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007891225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist