Provider Demographics
NPI:1437460557
Name:COLE, ADAM PHILLIP (LMT)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:PHILLIP
Last Name:COLE
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8109 COOPER CREEK BLVD
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PARK
Mailing Address - State:FL
Mailing Address - Zip Code:34201-2004
Mailing Address - Country:US
Mailing Address - Phone:941-366-1168
Mailing Address - Fax:941-360-1125
Practice Address - Street 1:8109 COOPER CREEK BLVD
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PARK
Practice Address - State:FL
Practice Address - Zip Code:34201-2004
Practice Address - Country:US
Practice Address - Phone:941-366-1168
Practice Address - Fax:941-360-1125
Is Sole Proprietor?:No
Enumeration Date:2010-06-23
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA57471225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist