Provider Demographics
NPI:1396007415
Name:COLE, AMY KATHLEEN (DPT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:KATHLEEN
Last Name:COLE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:KATHLEEN
Other - Last Name:GILLUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4080 W BROADWAY AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ROBBINSDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55422-5604
Mailing Address - Country:US
Mailing Address - Phone:763-533-0541
Mailing Address - Fax:763-533-1052
Practice Address - Street 1:4080 W BROADWAY AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:ROBBINSDALE
Practice Address - State:MN
Practice Address - Zip Code:55422-5604
Practice Address - Country:US
Practice Address - Phone:763-533-0541
Practice Address - Fax:763-533-1052
Is Sole Proprietor?:No
Enumeration Date:2012-06-14
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist