Provider Demographics
NPI:1649055906
Name:COLE, ZACHARY GRANT (DPT)
Entity type:Individual
Prefix:DR
First Name:ZACHARY
Middle Name:GRANT
Last Name:COLE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1070 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:VILONIA
Mailing Address - State:AR
Mailing Address - Zip Code:72173-9522
Mailing Address - Country:US
Mailing Address - Phone:501-796-3242
Mailing Address - Fax:501-796-3240
Practice Address - Street 1:1070 MAIN ST
Practice Address - Street 2:
Practice Address - City:VILONIA
Practice Address - State:AR
Practice Address - Zip Code:72173-9522
Practice Address - Country:US
Practice Address - Phone:501-796-3242
Practice Address - Fax:501-796-3240
Is Sole Proprietor?:No
Enumeration Date:2023-08-25
Last Update Date:2023-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR5359225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist