Provider Demographics
NPI:1366923625
Name:KOLESSAR, ANNE ELIZABETH (LMT, CCT)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:ELIZABETH
Last Name:KOLESSAR
Suffix:
Gender:F
Credentials:LMT, CCT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6408 GAMBEL QUAIL RD NE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87144-5141
Mailing Address - Country:US
Mailing Address - Phone:505-850-8897
Mailing Address - Fax:505-274-7672
Practice Address - Street 1:2469 CORRALES RD
Practice Address - Street 2:
Practice Address - City:CORRALES
Practice Address - State:NM
Practice Address - Zip Code:87048-9146
Practice Address - Country:US
Practice Address - Phone:505-508-5827
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-24
Last Update Date:2018-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM8804225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist