Provider Demographics
NPI:1487053096
Name:COX, COLLEEN (DPT)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:COX
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 SPRING FOREST RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27616-2815
Mailing Address - Country:US
Mailing Address - Phone:508-091-9424
Mailing Address - Fax:
Practice Address - Street 1:166 SPRINGBROOK AVE STE 201
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27520-8520
Practice Address - Country:US
Practice Address - Phone:919-535-8461
Practice Address - Fax:919-535-8459
Is Sole Proprietor?:No
Enumeration Date:2014-08-19
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60480563225100000X
NCP16683225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0329951OtherDEPT. OF LABOR AND INDUSTRIES
WA2039185Medicaid
WAG8934712Medicare PIN