Provider Demographics
NPI:1588675656
Name:COLE, CARLTON S JR (PT)
Entity Type:Individual
Prefix:
First Name:CARLTON
Middle Name:S
Last Name:COLE
Suffix:JR
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
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Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:894 ISLAND WAY
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33767-1825
Mailing Address - Country:US
Mailing Address - Phone:772-233-5487
Mailing Address - Fax:
Practice Address - Street 1:180 ALT US 19 N
Practice Address - Street 2:SUITE B
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34683
Practice Address - Country:US
Practice Address - Phone:727-785-8737
Practice Address - Fax:727-786-8546
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL23693225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL23693OtherPHYSICAL THERAPY LIC #