Provider Demographics
NPI:1023407665
Name:COLE, AMY (PT)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:COLE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 NE WOLF CREEK RD
Mailing Address - Street 2:
Mailing Address - City:MAYSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64469-9020
Mailing Address - Country:US
Mailing Address - Phone:816-449-2054
Mailing Address - Fax:
Practice Address - Street 1:27442 PORTOLA PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:FOOTHILL RANCH
Practice Address - State:CA
Practice Address - Zip Code:92610-2823
Practice Address - Country:US
Practice Address - Phone:949-282-5900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-20
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO01859225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist