Provider Demographics
NPI:1881970127
Name:COLE, BRIAN SHUNTEL (ATP)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:SHUNTEL
Last Name:COLE
Suffix:
Gender:M
Credentials:ATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2505 WHEELWRIGHT PL
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75044-6362
Mailing Address - Country:US
Mailing Address - Phone:469-258-1264
Mailing Address - Fax:214-363-2445
Practice Address - Street 1:11317 N CENTRAL EXPY
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-6703
Practice Address - Country:US
Practice Address - Phone:214-363-2289
Practice Address - Fax:214-363-2445
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-01
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX332B00000X, 332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies