MEDICARE: COLE PEDIATRIC THERAPY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2251P0200X	Pediatric Physical Therapist	8357	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023447554
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLE PEDIATRIC THERAPY

Provider Business Mailing Address
First Line	:	12370 STRONG HEART TRL
Second Line	:
City	:	ARLINGTON
State	:	TN
Zip	:	38002-4063
Country	:	US
Telephone Number	:	901-482-3997
Fax Number	:

Provider Business Practice Location Address
First Line	:	12370 STRONG HEART TRL
Second Line	:
City	:	ARLINGTON
State	:	TN
Zip	:	38002-4063
Country	:	US
Telephone Number	:	901-482-3997
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. AMBER T COLE
Credential	:	PT
Telephone Number	:	901-482-3997

Provider Enumeration Date	:	11/05/2013
Last Update Date	:	11/05/2013

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