Provider Demographics
NPI:1619344694
Name:COLE, ELLEN PEARSON (PT DPT)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:PEARSON
Last Name:COLE
Suffix:
Gender:F
Credentials:PT DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6847 HAMILTON MIDDLETOWN RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45044-7812
Mailing Address - Country:US
Mailing Address - Phone:513-571-1036
Mailing Address - Fax:
Practice Address - Street 1:1879 DEERFIELD RD
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OH
Practice Address - Zip Code:45036-8602
Practice Address - Country:US
Practice Address - Phone:513-695-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-26
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH015405225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist