Provider Demographics
NPI:1407890890
Name:COOLEY, PATRICK J (DC, PT)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:J
Last Name:COOLEY
Suffix:
Gender:M
Credentials:DC, PT
Other - Prefix:
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Mailing Address - Street 1:71 ALLEN ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701-4570
Mailing Address - Country:US
Mailing Address - Phone:802-773-7700
Mailing Address - Fax:802-773-7720
Practice Address - Street 1:71 ALLEN ST
Practice Address - Street 2:SUITE 203
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-4570
Practice Address - Country:US
Practice Address - Phone:802-773-7700
Practice Address - Fax:802-773-7720
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VT006-0001110111N00000X
VT040-0003483225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
4260800OtherCIGNA
383814OtherMVP PT
NYQ29P4OtherEMPIREBLUECROSSBLUESHIELD
10102836OtherCDPHP
NYX09C0OtherEMPIREBLUECROSSBLUESHIELD
00058751OtherBCBS PT INDIVIDUAL
00058780OtherBCBS INDIVIDUAL CHIRO
610903200OtherEMPLY STANADARDS ADM CHIR
610903300OtherEMPLYMNT STANDRDS ADMN PT
NYX09C01OtherEMPIREBCBSCHIRO
NYQ29P4OtherEMPIREBLUECROSSBLUESHIELD
GAP00296181Medicare PIN
383814OtherMVP PT
610903300OtherEMPLYMNT STANDRDS ADMN PT