Provider Demographics
NPI:1073555637
Name:COOLEY, KERRY (PT)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:
Last Name:COOLEY
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 1:6342 GRAND HICKORY DR STE 102
Mailing Address - Street 2:
Mailing Address - City:BRASELTON
Mailing Address - State:GA
Mailing Address - Zip Code:30517-4069
Mailing Address - Country:US
Mailing Address - Phone:770-967-2177
Mailing Address - Fax:770-967-2014
Practice Address - Street 1:6342 GRAND HICKORY DR STE 102
Practice Address - Street 2:
Practice Address - City:BRASELTON
Practice Address - State:GA
Practice Address - Zip Code:30517-4069
Practice Address - Country:US
Practice Address - Phone:770-967-2177
Practice Address - Fax:770-967-2014
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT008084225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA52010165-007OtherBCBS
GA52010165-007OtherBCBS