Provider Demographics
NPI:1396225017
Name:COOKE, ELIZABETH DOLLAR (PTA)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:DOLLAR
Last Name:COOKE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2624 LOU JOHN ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78727-1243
Mailing Address - Country:US
Mailing Address - Phone:512-923-5450
Mailing Address - Fax:
Practice Address - Street 1:17751 PARK VALLEY DR
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-3592
Practice Address - Country:US
Practice Address - Phone:512-218-6013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-21
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2120886225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2120886OtherTEXAS BOARD OF PHYSICAL THERAPY EXAMINERS