Provider Demographics
NPI:1225566458
Name:COOKSLEY, SARA ANN (ATC)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:ANN
Last Name:COOKSLEY
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81830 HIGHWAY 2
Mailing Address - Street 2:
Mailing Address - City:ANSELMO
Mailing Address - State:NE
Mailing Address - Zip Code:68813-7845
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2021 S E ST STE 1
Practice Address - Street 2:
Practice Address - City:BROKEN BOW
Practice Address - State:NE
Practice Address - Zip Code:68822-1811
Practice Address - Country:US
Practice Address - Phone:308-872-5803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-01
Last Update Date:2017-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer