Individual
COLE JEAVONS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
1414 HOSPITAL ST, GREENVILLE, MS 38703-3217
(601) 946-0312
Mailing address
360 W 13TH AVE UNIT 820, DENVER, CO 80204-2728
(601) 946-0312
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA6927
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PTA6927
PTA LICENSE
MS
Enumeration date
03/24/2021
Last updated
03/24/2021
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