Provider Demographics
NPI:1588329569
Name:KOLENBERG, OLGA (PT)
Entity type:Individual
Prefix:
First Name:OLGA
Middle Name:
Last Name:KOLENBERG
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:11 BERTMOR DR
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-2114
Mailing Address - Country:US
Mailing Address - Phone:203-512-4149
Mailing Address - Fax:203-990-3393
Practice Address - Street 1:132 E PUTNAM AVE STE 14
Practice Address - Street 2:
Practice Address - City:COS COB
Practice Address - State:CT
Practice Address - Zip Code:06807-2753
Practice Address - Country:US
Practice Address - Phone:203-512-4149
Practice Address - Fax:203-358-0052
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-03
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT0068822081P0010X, 2251P0200X, 261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No2081P0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPediatric Rehabilitation Medicine
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics