Provider Demographics
NPI:1083727754
Name:COX, GRETCHEN BRAKER (PT)
Entity Type:Individual
Prefix:MS
First Name:GRETCHEN
Middle Name:BRAKER
Last Name:COX
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 1:801 S BRIGGS ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60433-9591
Mailing Address - Country:US
Mailing Address - Phone:815-722-1757
Mailing Address - Fax:815-722-1767
Practice Address - Street 1:19807 SOUTH LAGRANGE ROAD
Practice Address - Street 2:
Practice Address - City:MOKENA
Practice Address - State:IL
Practice Address - Zip Code:60448
Practice Address - Country:US
Practice Address - Phone:708-478-8208
Practice Address - Fax:708-478-8306
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL70005119225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist