Provider Demographics
NPI:1699119370
Name:KOLDEN, ELIZABETH CLAIRE (PTA)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:CLAIRE
Last Name:KOLDEN
Suffix:
Gender:F
Credentials:PTA
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Other - Credentials:
Mailing Address - Street 1:914 S SCHEUBER RD
Mailing Address - Street 2:REHAB THERAPIES-PROVIDENCE CENTRALIA HOSPTIAL
Mailing Address - City:CENTRALIA
Mailing Address - State:WA
Mailing Address - Zip Code:98531
Mailing Address - Country:US
Mailing Address - Phone:360-330-8720
Mailing Address - Fax:360-330-8737
Practice Address - Street 1:914 S SCHEUBER RD
Practice Address - Street 2:REHAB THERAPIES-PROVIDENCE CENTRALIA HOSPTIAL
Practice Address - City:CENTRALIA
Practice Address - State:WA
Practice Address - Zip Code:98531
Practice Address - Country:US
Practice Address - Phone:360-330-8720
Practice Address - Fax:360-330-8737
Is Sole Proprietor?:No
Enumeration Date:2013-04-24
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAP160303332225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant