| Doctor Name: | MR. BENJAMIN LAWRENCE KOLLY |
| NPI Number: | 1245365188 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PT, OMPT, ATC |
| License Number: | 5501011967 |
| Business Practice Address: | 351 S Straits Hwy Indian River, MI - 49749 |
| Business Phone Number: | 2312382302 |
| Business Fax Number: | 2312382303 |
| Mailing Address: | P. O. Box 829, 351 S Straits Hwy INDIAN RIVER |
| State: | MI |
| Postal Code: | 49749 |
| Phone Number: | 2312382302 |
| Fax Number: | 2312382303 |
| NPI Enumeration Date: | 02/22/2007 |
| NPI Last Update Date: | 03/27/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 5501011967 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |