Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 1175598 | TX |
N | 2251X0800X | Physical Therapist - Orthopedic | 1175598 | TX |
NPI | 1023209962 |
---|---|
Provider Name | Miss Cassi Lee Cole |
First Address | Plano, TX 75023-3210 |
Second Address | Fort Worth, TX 76244-9105 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/08/2007 |
Last Update Date | 13/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1175598 | PHYSICAL THERAPY LICENSE (01) | TX |
1K9617 | MEDICARE (01) | TX |
854T75 | BCBS ORTHOTEXAS (01) | TX |
P00954311 | RAILROAD MEDICARE (01) | TX |
TXB119301 | MEDICARE PIN (01) | TX |