Provider Demographics
NPI:1477708840
Name:COLE, MICHAEL (MPT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:COLE
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 1ST ST N
Mailing Address - Street 2:SUITE 200
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-6945
Mailing Address - Country:US
Mailing Address - Phone:888-909-5038
Mailing Address - Fax:888-794-5038
Practice Address - Street 1:4710 SLIDE RD
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79414-3404
Practice Address - Country:US
Practice Address - Phone:806-797-3481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-25
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1184657225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist