Provider Demographics
NPI:1366477523
Name:COLE, PAULA DIANE (MPT)
Entity Type:Individual
Prefix:MRS
First Name:PAULA
Middle Name:DIANE
Last Name:COLE
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:337 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23430-1346
Mailing Address - Country:US
Mailing Address - Phone:757-408-4068
Mailing Address - Fax:757-357-2018
Practice Address - Street 1:337 MAIN ST
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:VA
Practice Address - Zip Code:23430-1346
Practice Address - Country:US
Practice Address - Phone:757-408-4068
Practice Address - Fax:757-357-2018
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305005851225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist