Provider Demographics
NPI:1629575998
Name:COLE, WILLIAM ALEXANDER
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:ALEXANDER
Last Name:COLE
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 1:710 HARPOLD AVE
Mailing Address - Street 2:
Mailing Address - City:RAVENSWOOD
Mailing Address - State:WV
Mailing Address - Zip Code:26164-1340
Mailing Address - Country:US
Mailing Address - Phone:304-532-3914
Mailing Address - Fax:
Practice Address - Street 1:74 MIZPAH RD
Practice Address - Street 2:
Practice Address - City:LOCUST HILL
Practice Address - State:VA
Practice Address - Zip Code:23092-9808
Practice Address - Country:US
Practice Address - Phone:804-758-5260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-12
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305211820225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist