Provider Demographics
NPI:1558763573
Name:COLE, REBECCA (ATC, LAT)
Entity Type:Individual
Prefix:MISS
First Name:REBECCA
Middle Name:
Last Name:COLE
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:MRS
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:BATES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ATC, LAT
Mailing Address - Street 1:15315 HOPE SHADOW CT
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-6238
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14777 VOSS RD
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77498-2125
Practice Address - Country:US
Practice Address - Phone:281-634-2363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-22
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT54302255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer