Provider Demographics
NPI:1598797607
Name:COLES, ISIAH
Entity Type:Individual
Prefix:MR
First Name:ISIAH
Middle Name:
Last Name:COLES
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:ISIAH
Other - Middle Name:
Other - Last Name:COLES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAT, ATC
Mailing Address - Street 1:3650 FOREST HILL BLVD STE 4
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33406-5662
Mailing Address - Country:US
Mailing Address - Phone:561-304-7171
Mailing Address - Fax:
Practice Address - Street 1:3650 FOREST HILL BLVD STE 4
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33406-5662
Practice Address - Country:US
Practice Address - Phone:561-304-7171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL 11922255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer