Provider Demographics
NPI:1396474466
Name:COLE, STEPHEN (PT)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:COLE
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 1:8325 2ND ST NW
Mailing Address - Street 2:
Mailing Address - City:LOS RANCHOS DE ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-1013
Mailing Address - Country:US
Mailing Address - Phone:631-894-7080
Mailing Address - Fax:
Practice Address - Street 1:8325 2ND ST NW
Practice Address - Street 2:
Practice Address - City:LOS RANCHOS DE ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-1013
Practice Address - Country:US
Practice Address - Phone:505-266-3655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-06
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
DEJ1-0014553225100000X
NMPT-2024-0202225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist