Provider Demographics
NPI:1326134347
Name:COOKE, DEBORAH LEE (PT, PHD)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:LEE
Last Name:COOKE
Suffix:
Gender:F
Credentials:PT, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 BROADWAY
Mailing Address - Street 2:SUITE 507
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111
Mailing Address - Country:US
Mailing Address - Phone:816-679-7056
Mailing Address - Fax:816-931-7392
Practice Address - Street 1:3100 BROADWAY ST
Practice Address - Street 2:SUITE 507
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-2658
Practice Address - Country:US
Practice Address - Phone:816-679-7056
Practice Address - Fax:816-931-7392
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO05562251N0400X
KS11-028782251N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO32911028OtherBLUE CROSS BLUE SHIELD
KS399054OtherBLUE CROSS BLUE SHIELD
KSR550000AMedicare ID - Type UnspecifiedPRACTICE MEDICARE NUMBER
MOR550000Medicare ID - Type UnspecifiedPRACTICE MEDICARE NUMBER
KS399054OtherBLUE CROSS BLUE SHIELD
MO32911028OtherBLUE CROSS BLUE SHIELD