Healthcare Provider Details

I. General information

NPI: 1063909141
Provider Name (Legal Business Name): PAULA RUBIN-COLE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2018
Last Update Date: 04/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4712 CHESTER AVE
PHILADELPHIA PA
19143-3513
US

IV. Provider business mailing address

509 S 46TH ST
PHILADELPHIA PA
19143-2101
US

V. Phone/Fax

Practice location:
  • Phone: 215-727-4450
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT003217L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: