Healthcare Provider Details

I. General information

NPI: 1588303093
Provider Name (Legal Business Name): REBEKAH COLE DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2022
Last Update Date: 07/27/2023
Certification Date: 07/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 E 70TH ST STE A
SHREVEPORT LA
71105-5345
US

IV. Provider business mailing address

1950 E 70TH ST STE A
SHREVEPORT LA
71105-5345
US

V. Phone/Fax

Practice location:
  • Phone: 318-219-6064
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number11167
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: