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General NPI Number Information
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NPI Number | 1568297315
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Entity Type | Individual
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Provider Name | COLE BERWEILER PTA
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Gender | Male
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Dates
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Enumeration Date | 09/03/2024
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Last Update Date | 09/03/2024
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Provider Practice Location Address
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Address Line | 30135 AGOURA RD STE C
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City | AGOURA HILLS
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State | CA
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Zip | 91301-4338
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Country | US
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Telephone | 818-707-7344
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Fax | 818-707-7133
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Provider Business Mailing Address
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Address Line | 25115 AVENUE STANFORD STE B135
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City | VALENCIA
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State | CA
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Zip | 91355-1290
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Country | US
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Telephone | 661-250-9940
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Fax | 661-250-9959
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 53327
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License Number State | CA
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