Provider Demographics
NPI:1578767125
Name:WAY, MICHAEL COLE (PT, ATC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:COLE
Last Name:WAY
Suffix:
Gender:M
Credentials:PT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 CROSSGLENN DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-9758
Mailing Address - Country:US
Mailing Address - Phone:336-712-1981
Mailing Address - Fax:
Practice Address - Street 1:131 MILLER ST
Practice Address - Street 2:COMPREHAB PLAZA
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-2508
Practice Address - Country:US
Practice Address - Phone:336-716-8113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9684225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist