Provider Demographics
NPI:1093523839
Name:KOLB, GERARDUS (MT)
Entity type:Individual
Prefix:
First Name:GERARDUS
Middle Name:
Last Name:KOLB
Suffix:
Gender:M
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 1/2 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45322-1323
Mailing Address - Country:US
Mailing Address - Phone:937-287-3721
Mailing Address - Fax:
Practice Address - Street 1:2555 S DIXIE DR STE 250
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45409-1518
Practice Address - Country:US
Practice Address - Phone:937-287-3721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-26
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.027271225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist