Provider Demographics
NPI:1629308622
Name:COOKE, MILDRED H (PT)
Entity Type:Individual
Prefix:MS
First Name:MILDRED
Middle Name:H
Last Name:COOKE
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 1:28 PUUHINA ST
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-2025
Mailing Address - Country:US
Mailing Address - Phone:808-937-5963
Mailing Address - Fax:808-935-2370
Practice Address - Street 1:28 PUUHINA ST
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-2025
Practice Address - Country:US
Practice Address - Phone:808-937-5963
Practice Address - Fax:808-935-2370
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-13
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI15302251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic