Provider Demographics
NPI:1205850161
Name:COLE, JAMES ALBERT (RPT)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:ALBERT
Last Name:COLE
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 100 PMB 613
Mailing Address - Street 2:
Mailing Address - City:MAMMOTH LAKES
Mailing Address - State:CA
Mailing Address - Zip Code:93546-0613
Mailing Address - Country:US
Mailing Address - Phone:760-924-8413
Mailing Address - Fax:760-924-8441
Practice Address - Street 1:218 SIERRA PARK RD
Practice Address - Street 2:SUITE 204
Practice Address - City:MAMMOTH LAKES
Practice Address - State:CA
Practice Address - Zip Code:93546
Practice Address - Country:US
Practice Address - Phone:760-924-8413
Practice Address - Fax:760-924-8441
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA651206606174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA651206606OtherPHYSICAL THERAPY
CA0PT781000Medicare ID - Type UnspecifiedPHYSICAL THERAPY