Provider Demographics
NPI:1235319716
Name:CASBON, COLE E (PT)
Entity Type:Individual
Prefix:MR
First Name:COLE
Middle Name:E
Last Name:CASBON
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 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:
Practice Address - Street 1:505 SILHAVY RD
Practice Address - Street 2:SUITE 700
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-4460
Practice Address - Country:US
Practice Address - Phone:219-548-9021
Practice Address - Fax:219-548-9022
Is Sole Proprietor?:No
Enumeration Date:2007-11-13
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05007002A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200362720Medicaid
IN555850007Medicare PIN