Healthcare Provider Details

I. General information

NPI: 1841472313
Provider Name (Legal Business Name): ABBY COLES-JOHNSON P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ABBY COLES

II. Dates (important events)

Enumeration Date: 11/27/2007
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 E EVERGREEN ST
CAMERON MO
64429
US

IV. Provider business mailing address

246 SE 84TH AVE
PORTLAND OR
97216-1023
US

V. Phone/Fax

Practice location:
  • Phone: 816-632-2101
  • Fax:
Mailing address:
  • Phone: 573-673-6734
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number6139
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2004017380
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: