Provider Demographics
NPI:1215074398
Name:COLE, KATIE JO (MPT, DPT)
Entity type:Individual
Prefix:MRS
First Name:KATIE
Middle Name:JO
Last Name:COLE
Suffix:
Gender:F
Credentials:MPT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2775 SW 17TH PL
Mailing Address - Street 2:SUITE 1
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-1254
Mailing Address - Country:US
Mailing Address - Phone:541-261-2246
Mailing Address - Fax:949-224-7775
Practice Address - Street 1:2775 SW 17TH PL
Practice Address - Street 2:SUITE 1
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-1254
Practice Address - Country:US
Practice Address - Phone:541-261-2246
Practice Address - Fax:949-224-7775
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4211225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist