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NPI Code Detail

MEDICARE: COLE BUDVARSON DPT

MEDICARE: COLE BUDVARSON 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
1225100000XPhysical Therapist1339905TX

General Provider Information

NPI Number : 1578166047
Entity Type Code : Individual
Provider Name (Legal Business Name) : COLE BUDVARSON DPT
Provider Business Mailing Address
First Line : 4867 COLE ST
Second Line :
City : FORT WORTH
State : TX
Zip : 76115-3613
Country : US
Telephone Number : 619-402-9195
Fax Number :
Provider Business Practice Location Address
First Line : 1106 ALSTON AVE STE 120
Second Line :
City : FORT WORTH
State : TX
Zip : 76104-4622
Country : US
Telephone Number : 817-332-0660
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/18/2020
Last Update Date : 11/18/2020

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Directions to “ COLE BUDVARSON DPT” Practice Location

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