Provider Demographics
NPI:1497353270
Name:NIESSINK, COLE DARWIN (PT)
Entity Type:Individual
Prefix:
First Name:COLE
Middle Name:DARWIN
Last Name:NIESSINK
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10790 RANCHO BERNARDO RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-5705
Mailing Address - Country:US
Mailing Address - Phone:760-633-6507
Mailing Address - Fax:
Practice Address - Street 1:3905 WARING RD
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-4405
Practice Address - Country:US
Practice Address - Phone:760-724-9000
Practice Address - Fax:760-724-3686
Is Sole Proprietor?:No
Enumeration Date:2020-10-13
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA298605225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist