Provider Demographics
NPI:1679675474
Name:COOK, DIANE MYERS (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:MYERS
Last Name:COOK
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 568
Mailing Address - Street 2:HEARTLAND REHABILITATION SERVICES
Mailing Address - City:BUCHANAN
Mailing Address - State:VA
Mailing Address - Zip Code:24066
Mailing Address - Country:US
Mailing Address - Phone:540-254-2126
Mailing Address - Fax:540-254-2393
Practice Address - Street 1:19733 MAIN ST
Practice Address - Street 2:HEARTLAND REHABILITATION SERVICES
Practice Address - City:BUCHANAN
Practice Address - State:VA
Practice Address - Zip Code:24066
Practice Address - Country:US
Practice Address - Phone:540-254-2126
Practice Address - Fax:540-254-2393
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA2305002849225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist