Provider Demographics
NPI:1578014601
Name:COOK, MARIA (PT)
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:
Last Name:COOK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14555 W NATIONAL AVE
Mailing Address - Street 2:SUITE 195
Mailing Address - City:NEW BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53151-4494
Mailing Address - Country:US
Mailing Address - Phone:262-827-2929
Mailing Address - Fax:262-827-2924
Practice Address - Street 1:14555 W NATIONAL AVE
Practice Address - Street 2:SUITE 195
Practice Address - City:NEW BERLIN
Practice Address - State:WI
Practice Address - Zip Code:53151-4494
Practice Address - Country:US
Practice Address - Phone:262-827-2929
Practice Address - Fax:262-827-2924
Is Sole Proprietor?:No
Enumeration Date:2016-10-24
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4392-242251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic