Provider Demographics
NPI:1861941460
Name:OLMON, COLE
Entity type:Individual
Prefix:
First Name:COLE
Middle Name:
Last Name:OLMON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 S REINO RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NEWBURY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91320-4284
Mailing Address - Country:US
Mailing Address - Phone:805-277-2233
Mailing Address - Fax:805-277-0623
Practice Address - Street 1:400 S REINO RD
Practice Address - Street 2:SUITE 100
Practice Address - City:NEWBURY PARK
Practice Address - State:CA
Practice Address - Zip Code:91320-4284
Practice Address - Country:US
Practice Address - Phone:805-277-2233
Practice Address - Fax:805-277-0623
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-25
Last Update Date:2016-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA292037225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist