Provider Demographics
NPI:1437302726
Name:COOK, TINA L (DPT)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:L
Last Name:COOK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 S 21ST ST
Mailing Address - Street 2:SUITE 130
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80904-3762
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:600 S 21ST ST
Practice Address - Street 2:SUITE 130
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80904-3762
Practice Address - Country:US
Practice Address - Phone:719-634-1110
Practice Address - Fax:719-634-1112
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-30
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501013891225100000X
COPTL-10205225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist