Provider Demographics
NPI:1588846919
Name:COOK, MICHELLE (PT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
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 1:605 E GRANT ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004-2670
Mailing Address - Country:US
Mailing Address - Phone:866-221-1870
Mailing Address - Fax:877-673-6571
Practice Address - Street 1:1401 GATEWAY BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:ROCK SPRINGS
Practice Address - State:WY
Practice Address - Zip Code:82901-6717
Practice Address - Country:US
Practice Address - Phone:307-352-3626
Practice Address - Fax:307-352-3628
Is Sole Proprietor?:No
Enumeration Date:2007-11-27
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPT269225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY116116400Medicaid
W309136Medicare PIN