Basic Information
| Provider Information | |||||||||
| NPI: | 1437199080 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KOLE | ||||||||
| FirstName: | SUZANNE | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | MPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3869 HIGHWAY 81 SOUTH | ||||||||
| Address2: | |||||||||
| City: | LOGANVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300523918 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6786358280 | ||||||||
| FaxNumber: | 6786358285 | ||||||||
| Practice Location | |||||||||
| Address1: | 3869 HIGHWAY 81 SOUTH | ||||||||
| Address2: | |||||||||
| City: | LOGANVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300523918 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6786358280 | ||||||||
| FaxNumber: | 6786358285 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2006 | ||||||||
| LastUpdateDate: | 10/10/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 2035 | NV | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | PT009186 | GA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 6789 | SC | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.