Healthcare Provider Details

I. General information

NPI: 1861445231
Provider Name (Legal Business Name): KATHRYN ANNE COLE MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 E. GOLDEN AVENUE
PLACENTIA CA
92870
US

IV. Provider business mailing address

603 N LYALL AVE
WEST COVINA CA
91790-1829
US

V. Phone/Fax

Practice location:
  • Phone: 714-993-2093
  • Fax:
Mailing address:
  • Phone: 626-974-6972
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPT23835
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: