Provider Demographics
NPI:1871784264
Name:COLE, LENNY ESTELA (PT)
Entity type:Individual
Prefix:MRS
First Name:LENNY
Middle Name:ESTELA
Last Name:COLE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:LENNY ESTELA
Other - Middle Name:BATOON
Other - Last Name:AGSALDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:500 E CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33880-3053
Mailing Address - Country:US
Mailing Address - Phone:863-293-1191
Mailing Address - Fax:
Practice Address - Street 1:500 E CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-3053
Practice Address - Country:US
Practice Address - Phone:863-293-1191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-09
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT23374225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist