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General NPI Number Information
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NPI Number | 1992435929
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Entity Type | Individual
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Provider Name | MICHAEL COLES CMT, CES
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Gender | Male
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Dates
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Enumeration Date | 06/13/2022
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Last Update Date | 06/13/2022
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Provider Practice Location Address
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Address Line | 4110 FITZHUGH AVE
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City | RICHMOND
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State | VA
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Zip | 23230-3827
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Country | US
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Telephone | 804-380-1316
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Fax |
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Provider Business Mailing Address
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Address Line | 2409 SKEET ST
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City | HENRICO
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State | VA
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Zip | 23294-3501
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Country | US
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Telephone | 804-380-1316
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 0019008127
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License Number State | VA
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