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Organization
VIVID PERFORMANCE PHYSICAL THERAPY
Active
Organization
VIVID PERFORMANCE PHYSICAL THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SPENCER ANDREW COLE PT,DPT,OCS,CSCS (OWNER)
(269) 377-5117
Entity
Organization
Contact information
Practice address
1517 15TH STREET, NORTHLAKE, TX 76226
(269) 377-5117
Mailing address
1517 15TH STREET, NORTHLAKE, TX 76226
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
2251S0007X
Sports Physical Therapist
—
—
2251X0800X
Orthopedic Physical Therapist
—
—
Other
Enumeration date
11/13/2019
Last updated
11/13/2019
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