Healthcare Provider Details

I. General information

NPI: 1457391054
Provider Name (Legal Business Name): COLE DAVID TAYLOR PHYSICAL THERAPIST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5586 LEGIONNAIRE DR SUITE 6
CICERO NY
13039-3504
US

IV. Provider business mailing address

5586 LEGIONNAIRE DR SUITE 6
CICERO NY
13039-3504
US

V. Phone/Fax

Practice location:
  • Phone: 315-698-9353
  • Fax: 315-698-4463
Mailing address:
  • Phone: 315-698-9353
  • Fax: 315-698-4463

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number012257
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: