Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 3930 | NE |
Y | 225100000X | Physical Therapist |
NPI | 1033775622 |
---|---|
Provider Name | Shane Cole |
First Address | Omaha, NE 68134-0699 |
Second Address | Bellevue, NE 68005-7918 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2019 |
Last Update Date | 22/07/2019 |