Active NPI
Kimberly Diane Kolodji, P.T.
- Physical Therapist
- Mount Pleasant, SC
National Provider Identifier
1114253036
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 6901
- Practice address
- 217 Lucas St Ste C
Mount Pleasant, SC 29464-4381 - Phone
- (843) 628-2221
- NPI assigned
- Oct 28, 2009
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 6901 | SC | Primary |
Addresses
Primary practice location
217 Lucas St Ste C
Mount Pleasant, SC 29464-4381
Mailing address
3024 Fraserburgh Way
Mount Pleasant, SC 29466-9385
Phone (816) 588-5008
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6901 | SC | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Olympic Physical Therapy LLC | Physical Therapist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Physical Therapist
- Mt Pleasant, SC
- NPI 1710060868
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1256688000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1542153600000",
"number": "1114253036",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3024 FRASERBURGH WAY",
"city": "MOUNT PLEASANT",
"state": "SC",
"postal_code": "294669385",
"telephone_number": "816-588-5008"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "217 LUCAS ST STE C",
"city": "MOUNT PLEASANT",
"state": "SC",
"postal_code": "294644381",
"telephone_number": "843-628-2221"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOLODJI",
"first_name": "KIMBERLY",
"middle_name": "DIANE",
"credential": "P.T.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-10-28",
"last_updated": "2018-11-14",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "SC",
"license": "6901",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mount Pleasant, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.