Provider Demographics
NPI:1093835175
Name:COOK, ROBERT JAMES (PT)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:JAMES
Last Name:COOK
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3985 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075-2943
Mailing Address - Country:US
Mailing Address - Phone:716-771-8089
Mailing Address - Fax:
Practice Address - Street 1:3000 W MONROE RD
Practice Address - Street 2:SUITE B
Practice Address - City:ALMA
Practice Address - State:MI
Practice Address - Zip Code:48801-9719
Practice Address - Country:US
Practice Address - Phone:989-463-0345
Practice Address - Fax:989-466-5472
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2013-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501005257225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI650B910430OtherBCBS PROVIDER ID
MIOP28950Medicare ID - Type UnspecifiedGROUP NUMBER
MI650B910430OtherBCBS PROVIDER ID