Individual
MR. SHAWN ISHMAEL COLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
5 POMONA AVE, APT 2H, NEWARK, NJ 07112-2300
(973) 392-2320
Mailing address
5 POMONA AVE, APT 2H, NEWARK, NJ 07112-2300
(973) 392-2320
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
40QB00265900
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
40QB00265900
PTA LICENCE #
NJ
Enumeration date
07/28/2009
Last updated
07/28/2009
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