Provider Demographics
NPI:1063511103
Name:COOKE, ANNE ELISABETH (PT)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:ELISABETH
Last Name:COOKE
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 1:205 OSCEOLA ST
Mailing Address - Street 2:
Mailing Address - City:LAURIUM
Mailing Address - State:MI
Mailing Address - Zip Code:49913-2134
Mailing Address - Country:US
Mailing Address - Phone:906-337-6591
Mailing Address - Fax:906-337-6597
Practice Address - Street 1:903 RAZORBACK DR
Practice Address - Street 2:STE 3B
Practice Address - City:HOUGHTON
Practice Address - State:MI
Practice Address - Zip Code:49931-2824
Practice Address - Country:US
Practice Address - Phone:906-370-9646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501012946225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIAC012946Medicare UPIN