Provider Demographics
NPI:1871002188
Name:STUTZ, COLE (PT)
Entity Type:Individual
Prefix:
First Name:COLE
Middle Name:
Last Name:STUTZ
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23225 KINGSLAND BLVD STE 600
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-3705
Mailing Address - Country:US
Mailing Address - Phone:281-395-9090
Mailing Address - Fax:
Practice Address - Street 1:5401 LA CROSSE AVE.
Practice Address - Street 2:BUILDING C, SUITE 101
Practice Address - City:AUSTIN
Practice Address - State:TN
Practice Address - Zip Code:78739
Practice Address - Country:US
Practice Address - Phone:512-852-8134
Practice Address - Fax:512-852-8143
Is Sole Proprietor?:No
Enumeration Date:2017-09-29
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1296221225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist