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General NPI Number Information
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NPI Number | 1942577929
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Entity Type | Individual
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Provider Name | CHARLES COLE VICTOR VERTZ ATC, LAT
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Gender | Male
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Dates
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Enumeration Date | 11/19/2011
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Last Update Date | 09/12/2022
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Provider Practice Location Address
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Address Line | 704-A COLLEGE ST BARTON COLLEGE
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City | WILSON
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State | NC
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Zip | 27893
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Country | US
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Telephone | 252-399-6534
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Fax | 252-399-6516
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Provider Business Mailing Address
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Address Line | 4913 SUMMIT PLACE DR NW #708
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City | WILSON
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State | NC
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Zip | 27896-8171
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Country | US
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Telephone |
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Fax |
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 2020016742
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License Number State | MO
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