Provider Demographics
NPI:1346567104
Name:COLE, MICHAEL LESLIE (DPT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:LESLIE
Last Name:COLE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1940 HARVE AVE
Mailing Address - Street 2:SUIT 2
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-8332
Mailing Address - Country:US
Mailing Address - Phone:406-542-0808
Mailing Address - Fax:406-542-0909
Practice Address - Street 1:1940 HARVE AVE
Practice Address - Street 2:SUIT 2
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-8332
Practice Address - Country:US
Practice Address - Phone:406-542-0808
Practice Address - Fax:406-542-0909
Is Sole Proprietor?:No
Enumeration Date:2010-05-03
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT2315PT225100000X
MT51ATR2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer