Provider Demographics
NPI:1225573991
Name:COOKE, JEFFREY (PT)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:
Last Name:COOKE
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 1:404 BRUNN SCHOOL RD STE D
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-1102
Mailing Address - Country:US
Mailing Address - Phone:719-966-9278
Mailing Address - Fax:
Practice Address - Street 1:404 BRUNN SCHOOL RD STE D
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-1102
Practice Address - Country:US
Practice Address - Phone:719-966-9278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-04
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4968225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist