Provider Demographics
NPI:1235188343
Name:BANCOLITA-COOK, MARIA TERESA TRONGCO (PT)
Entity Type:Individual
Prefix:
First Name:MARIA TERESA
Middle Name:TRONGCO
Last Name:BANCOLITA-COOK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:TESS
Other - Middle Name:
Other - Last Name:COOK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:43648 SCHOENHERR RD
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48313-1113
Mailing Address - Country:US
Mailing Address - Phone:248-420-3395
Mailing Address - Fax:248-649-5998
Practice Address - Street 1:43648 SCHOENHERR RD
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48313
Practice Address - Country:US
Practice Address - Phone:586-604-9184
Practice Address - Fax:800-679-9769
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-08
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI550100426225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1235188343Medicaid