MEDICARE: MISS CASSI LEE COLE MPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2251X0800X	Orthopedic Physical Therapist	1175598	TX
2	225100000X	Physical Therapist	1175598	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00954311	OTHER	TX	RAILROAD MEDICARE
3	TXB119301	OTHER	TX	MEDICARE PIN
5	1K9617	OTHER	TX	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	854T75	OTHER	TX	BCBS ORTHOTEXAS
4	1175598	OTHER	TX	PHYSICAL THERAPY LICENSE

General Provider Information

NPI Number	:	1023209962
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS CASSI LEE COLE MPT

Provider Business Mailing Address
First Line	:	6640 OSAGE TRL
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75023-3210
Country	:	US
Telephone Number	:	214-770-0343
Fax Number	:

Provider Business Practice Location Address
First Line	:	3033 W GEORGE BUSH HWY STE 150
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75075-5752
Country	:	US
Telephone Number	:	972-390-7733
Fax Number	:	972-390-7738

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/06/2007
Last Update Date	:	12/14/2022

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Directions to “ MISS CASSI LEE COLE MPT” Practice Location

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