Provider Demographics
NPI:1194841981
Name:COLE, RONALD (PT)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:
Last Name:COLE
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 1:11901 SHELBYVILLE RD
Mailing Address - Street 2:SUITE 125
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40243-1077
Mailing Address - Country:US
Mailing Address - Phone:502-499-5559
Mailing Address - Fax:502-499-5399
Practice Address - Street 1:11901 SHELBYVILLE RD
Practice Address - Street 2:SUITE 125
Practice Address - City:MIDDLETOWN
Practice Address - State:KY
Practice Address - Zip Code:40243-1077
Practice Address - Country:US
Practice Address - Phone:502-499-5559
Practice Address - Fax:502-499-5399
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY003879225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY6400230OtherUNITED HEALTH CARE
KY87000303Medicaid
KY1148472OtherPASSPORT PIN
KYSCL 3300381Medicaid
KY00000019024OtherANTHEM PLANS
KY27237OtherBLUEGRASS FAMILY
KY2438452OtherPASSPORT ADVANTAGE PIN
KY6218148181OtherHUMANA
KY6414987OtherUHC ALL OTHER PLANS
KY7431202OtherAETNA
KY87000303Medicaid
KYSCL 3300381Medicaid