Provider Demographics
NPI:1265475529
Name:COOKE, DEBRA ANN (PT)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:ANN
Last Name:COOKE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:ANN
Other - Last Name:KEATING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:981 US HIGHWAY 22 FL 2
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807-2946
Mailing Address - Country:US
Mailing Address - Phone:201-801-7141
Mailing Address - Fax:
Practice Address - Street 1:1904 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:MANASQUAN
Practice Address - State:NJ
Practice Address - Zip Code:08736-1006
Practice Address - Country:US
Practice Address - Phone:732-528-1010
Practice Address - Fax:732-528-2139
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA008966002251X0800X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP00323751OtherRR MEDICARE
NJ101442V2NMedicare PIN
NJ101442VFMMedicare PIN
NJ101442Medicare PIN
NJP00323751OtherRR MEDICARE
NJ101442V2JMedicare PIN