Provider Demographics
NPI:1043427008
Name:COOK, MARCIA GEZELTER (PT)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:GEZELTER
Last Name:COOK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12690 PORTADA PL
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-2209
Mailing Address - Country:US
Mailing Address - Phone:858-350-9132
Mailing Address - Fax:
Practice Address - Street 1:9619 CHESAPEAKE DR
Practice Address - Street 2:SUITE 300
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1368
Practice Address - Country:US
Practice Address - Phone:858-715-7300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 18358225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist