Healthcare Provider Details

I. General information

NPI: 1578499190
Provider Name (Legal Business Name): PALACE ISABELLA COLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2460 MALL RD
FLORENCE AL
35630-2869
US

IV. Provider business mailing address

2460 MALL RD
FLORENCE AL
35630-2869
US

V. Phone/Fax

Practice location:
  • Phone: 256-202-4885
  • Fax:
Mailing address:
  • Phone: 256-202-4885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-522172
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: