Healthcare Provider Details

I. General information

NPI: 1275442261
Provider Name (Legal Business Name): COLE CARY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 VILLAGE AT GLYNN PL
BRUNSWICK GA
31525-1952
US

IV. Provider business mailing address

800 MALLERY ST APT 30
SAINT SIMONS ISLAND GA
31522-4039
US

V. Phone/Fax

Practice location:
  • Phone: 912-208-5170
  • Fax:
Mailing address:
  • Phone: 321-446-6206
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT018623
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: