Provider Demographics
NPI:1043381031
Name:COLE, VIRGINIA LAURENCIA (PT)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:LAURENCIA
Last Name:COLE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 LEE STREET
Mailing Address - Street 2:
Mailing Address - City:ROTHSCHILD
Mailing Address - State:WI
Mailing Address - Zip Code:54474
Mailing Address - Country:US
Mailing Address - Phone:715-849-7634
Mailing Address - Fax:715-298-0402
Practice Address - Street 1:3401 CRANBERRY BLVD
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:WI
Practice Address - Zip Code:54476-5217
Practice Address - Country:US
Practice Address - Phone:715-393-2100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10683-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist