Provider Demographics
NPI:1295300895
Name:COLE, DEBRA A X (LMT)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:A
Last Name:COLE
Suffix:X
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 1:709 N MAIN ST STE 1
Mailing Address - Street 2:
Mailing Address - City:NORTH SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13212-1659
Mailing Address - Country:US
Mailing Address - Phone:315-427-7408
Mailing Address - Fax:
Practice Address - Street 1:709 N MAIN ST STE 4
Practice Address - Street 2:
Practice Address - City:NORTH SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13212-1662
Practice Address - Country:US
Practice Address - Phone:315-427-7408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-25
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010036225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist