MEDICARE: MICHAEL LESLIE COLE DPT

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	225100000X	Physical Therapist	2315PT	MT
2	2255A2300X	Athletic Trainer	51ATR	MT

General Provider Information

NPI Number	:	1346567104
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL LESLIE COLE DPT

Provider Business Mailing Address
First Line	:	1940 HARVE AVE
Second Line	:	SUIT 2
City	:	MISSOULA
State	:	MT
Zip	:	59801-8332
Country	:	US
Telephone Number	:	406-542-0808
Fax Number	:	406-542-0909

Provider Business Practice Location Address
First Line	:	1940 HARVE AVE
Second Line	:	SUIT 2
City	:	MISSOULA
State	:	MT
Zip	:	59801-8332
Country	:	US
Telephone Number	:	406-542-0808
Fax Number	:	406-542-0909

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

Provider Enumeration Date	:	05/03/2010
Last Update Date	:	02/01/2011

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