Provider Demographics
NPI:1275181042
Name:COLE, KELLY ANN (MS, PT)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:ANN
Last Name:COLE
Suffix:
Gender:F
Credentials:MS, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16359 SUSSEX HWY
Mailing Address - Street 2:
Mailing Address - City:BRIDGEVILLE
Mailing Address - State:DE
Mailing Address - Zip Code:19933-2966
Mailing Address - Country:US
Mailing Address - Phone:302-337-7990
Mailing Address - Fax:
Practice Address - Street 1:16359 SUSSEX HWY
Practice Address - Street 2:
Practice Address - City:BRIDGEVILLE
Practice Address - State:DE
Practice Address - Zip Code:19933-2966
Practice Address - Country:US
Practice Address - Phone:302-337-7990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-26
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ1-0004102225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist