Provider Demographics
NPI:1497512933
Name:DELAINO, COLE EDWIN (PTA)
Entity Type:Individual
Prefix:
First Name:COLE
Middle Name:EDWIN
Last Name:DELAINO
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1711 MARTHA BERRY BLVD NW
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165-1623
Mailing Address - Country:US
Mailing Address - Phone:706-528-4207
Mailing Address - Fax:706-528-4211
Practice Address - Street 1:1711 MARTHA BERRY BLVD NW
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-1623
Practice Address - Country:US
Practice Address - Phone:706-528-4207
Practice Address - Fax:706-528-4211
Is Sole Proprietor?:No
Enumeration Date:2024-03-01
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant