Provider Demographics
NPI:1104181114
Name:COLE, JAMES MATT II (ATC/L)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:MATT
Last Name:COLE
Suffix:II
Gender:M
Credentials:ATC/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1116 E STOTTLER DR
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-3629
Mailing Address - Country:US
Mailing Address - Phone:480-545-5174
Mailing Address - Fax:
Practice Address - Street 1:1116 E STOTTLER DR
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-3629
Practice Address - Country:US
Practice Address - Phone:480-545-5174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-06
Last Update Date:2012-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ05652255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer