MEDICARE: MR. ISIAH COLES

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	2255A2300X	Athletic Trainer	AL 1192	FL

General Provider Information

NPI Number	:	1598797607
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ISIAH COLES

Provider Business Mailing Address
First Line	:	3650 FOREST HILL BLVD STE 4
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33406-5662
Country	:	US
Telephone Number	:	561-304-7171
Fax Number	:

Provider Business Practice Location Address
First Line	:	3650 FOREST HILL BLVD STE 4
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33406-5662
Country	:	US
Telephone Number	:	561-304-7171
Fax Number	:

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

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	07/21/2022

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