Provider Demographics
NPI:1033775622
Name:COLE, SHANE (PT)
Entity Type:Individual
Prefix:
First Name:SHANE
Middle Name:
Last Name:COLE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:PO BOX 34699
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68134-0699
Mailing Address - Country:US
Mailing Address - Phone:402-932-6731
Mailing Address - Fax:402-614-7835
Practice Address - Street 1:555 CORNHUSKER RD STE 207
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68005-7918
Practice Address - Country:US
Practice Address - Phone:402-614-4300
Practice Address - Fax:402-614-5211
Is Sole Proprietor?:No
Enumeration Date:2019-05-20
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE3930208100000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation