Healthcare Provider Details

I. General information

NPI: 1699947390
Provider Name (Legal Business Name): SCOTT WILLIAM WALLACE COLE ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2008
Last Update Date: 04/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

008 HPC UNIVERSITY OF NORTHERN IOWA
CEDAR FALLS IA
50614-0314
US

IV. Provider business mailing address

008 HPC UNIVERSITY OF NORTHERN IOWA
CEDAR FALLS IA
50613-0314
US

V. Phone/Fax

Practice location:
  • Phone: 715-498-0184
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number000664
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: