MEDICARE: COLE CABLE

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

General Provider Information

NPI Number	:	1720727407
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COLE CABLE

Provider Business Mailing Address
First Line	:	1200 CORPORATE DR STE 400
Second Line	:
City	:	HOOVER
State	:	AL
Zip	:	35242-5424
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1092 HAMPTON INN WAY STE 500
Second Line	:
City	:	JACKSONVILLE
State	:	NC
Zip	:	28546-7639
Country	:	US
Telephone Number	:	910-500-6882
Fax Number	:	910-202-4459

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

Provider Enumeration Date	:	06/01/2022
Last Update Date	:	06/01/2022

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Directions to “ COLE CABLE ” Practice Location

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