MEDICARE: SPENCER ANDREW COLE PT, DPT, OCS, SCS

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	225100000X	Physical Therapist	7787	SC
2	225100000X	Physical Therapist	P15612	NC

General Provider Information

NPI Number	:	1619350097
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SPENCER ANDREW COLE PT, DPT, OCS, SCS

Provider Business Mailing Address
First Line	:	1019 BROAD ST
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27705-4143
Country	:	US
Telephone Number	:	919-797-9588
Fax Number	:

Provider Business Practice Location Address
First Line	:	1019 BROAD ST
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27705-4143
Country	:	US
Telephone Number	:	864-454-0952
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/03/2015
Last Update Date	:	11/07/2023

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