Provider Demographics
NPI:1801339346
Name:COLE, KELLY JEAN (PT)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:JEAN
Last Name:COLE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:135 BUNTON CREEK RD
Mailing Address - Street 2:
Mailing Address - City:KYLE
Mailing Address - State:TX
Mailing Address - Zip Code:78640-5787
Mailing Address - Country:US
Mailing Address - Phone:512-268-4700
Mailing Address - Fax:512-268-4703
Practice Address - Street 1:135 BUNTON CREEK RD
Practice Address - Street 2:
Practice Address - City:KYLE
Practice Address - State:TX
Practice Address - Zip Code:78640-5787
Practice Address - Country:US
Practice Address - Phone:512-268-4700
Practice Address - Fax:512-268-4703
Is Sole Proprietor?:No
Enumeration Date:2016-12-01
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1280549225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist