Provider Demographics
NPI:1003681065
Name:SMITH, COLE WILLIAM
Entity Type:Individual
Prefix:
First Name:COLE
Middle Name:WILLIAM
Last Name:SMITH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 E DEVONSHIRE AVE UNIT 4004
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-4607
Mailing Address - Country:US
Mailing Address - Phone:949-285-5904
Mailing Address - Fax:
Practice Address - Street 1:16950 N 51ST AVE STE 3
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-1323
Practice Address - Country:US
Practice Address - Phone:623-233-2485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-20
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist