Provider Demographics
NPI:1598958936
Name:COOK, REBECCA SANSOM (PT)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:SANSOM
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 1:502 WOODLAND PARK
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78633-2033
Mailing Address - Country:US
Mailing Address - Phone:512-497-7123
Mailing Address - Fax:
Practice Address - Street 1:4402 WILLIAMS DR STE 115
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-1388
Practice Address - Country:US
Practice Address - Phone:512-256-7627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-20
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3724225100000X
TX1164738225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist