Provider Demographics
NPI:1538761614
Name:COLES, ADRIANE (LMT)
Entity type:Individual
Prefix:
First Name:ADRIANE
Middle Name:
Last Name:COLES
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14645 BANYAN BLUFF DR UNIT 204
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-5692
Mailing Address - Country:US
Mailing Address - Phone:303-731-9587
Mailing Address - Fax:
Practice Address - Street 1:14645 BANYAN BLUFF DR UNIT 204
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-5692
Practice Address - Country:US
Practice Address - Phone:303-731-9587
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-12
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA83446225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1720695208OtherZEEL