Provider Demographics
NPI:1558886499
Name:CHAMBERLIN, COLE
Entity Type:Individual
Prefix:
First Name:COLE
Middle Name:
Last Name:CHAMBERLIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 WHEATFIELD DR
Mailing Address - Street 2:STE 1
Mailing Address - City:MILFORD
Mailing Address - State:PA
Mailing Address - Zip Code:18337-7699
Mailing Address - Country:US
Mailing Address - Phone:570-296-5911
Mailing Address - Fax:570-296-5931
Practice Address - Street 1:100 WHEATFIELD DR STE 1
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:PA
Practice Address - Zip Code:18337-7699
Practice Address - Country:US
Practice Address - Phone:570-296-5911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-11
Last Update Date:2017-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT026314225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist