Provider Demographics
NPI:1679906655
Name:COOK, KERI
Entity Type:Individual
Prefix:
First Name:KERI
Middle Name:
Last Name:COOK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KERI
Other - Middle Name:
Other - Last Name:GASKILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:121 UMBRELLA PL
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-1622
Mailing Address - Country:US
Mailing Address - Phone:517-920-1700
Mailing Address - Fax:888-721-1997
Practice Address - Street 1:210 JUPITER LAKES BLVD STE 5101
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-7183
Practice Address - Country:US
Practice Address - Phone:561-741-1876
Practice Address - Fax:888-721-1997
Is Sole Proprietor?:No
Enumeration Date:2013-08-14
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL33743225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist