Healthcare Provider Details

I. General information

NPI: 1396474466
Provider Name (Legal Business Name): STEPHEN COLE PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2022
Last Update Date: 03/07/2025
Certification Date: 03/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8325 2ND ST NW
LOS RANCHOS DE ALBUQUERQUE NM
87114-1013
US

IV. Provider business mailing address

8325 2ND ST NW
LOS RANCHOS DE ALBUQUERQUE NM
87114-1013
US

V. Phone/Fax

Practice location:
  • Phone: 505-266-3655
  • Fax:
Mailing address:
  • Phone: 631-894-7080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberJ1-0014553
License Number StateDE
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT-2024-0202
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: