Provider Demographics
NPI:1073295705
Name:COOK, ANNA BETHANY (DPT)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:BETHANY
Last Name:COOK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 MONTVALE AVE STE Z
Mailing Address - Street 2:
Mailing Address - City:STONEHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02180-3600
Mailing Address - Country:US
Mailing Address - Phone:617-843-5320
Mailing Address - Fax:774-272-8474
Practice Address - Street 1:62 MONTVALE AVE STE Z
Practice Address - Street 2:
Practice Address - City:STONEHAM
Practice Address - State:MA
Practice Address - Zip Code:02180-3600
Practice Address - Country:US
Practice Address - Phone:617-843-5320
Practice Address - Fax:774-272-8474
Is Sole Proprietor?:No
Enumeration Date:2023-08-02
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA26960225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist