Provider Demographics
NPI:1073524179
Name:KOLE, LEE H (PT)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:H
Last Name:KOLE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 SOQUEL WAY
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94085-4102
Mailing Address - Country:US
Mailing Address - Phone:408-736-7600
Mailing Address - Fax:408-736-7604
Practice Address - Street 1:333 SOQUEL WAY
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94085-4102
Practice Address - Country:US
Practice Address - Phone:408-736-7600
Practice Address - Fax:408-736-7604
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2019-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 24011225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ29361ZOtherMEDICARE GROUP PTAN
CA1053320325OtherTYPE 2NPI
CAY09769Medicare UPIN
CAOPT240111Medicare PIN
CAY09769Medicare UPIN