Provider Demographics
NPI:1730100090
Name:COOK, MARY FRANCES (PT, LAC)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:FRANCES
Last Name:COOK
Suffix:
Gender:F
Credentials:PT, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5492
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31107
Mailing Address - Country:US
Mailing Address - Phone:404-444-7160
Mailing Address - Fax:
Practice Address - Street 1:1530 DEKALB AVE NE
Practice Address - Street 2:SUITE C
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30307-2176
Practice Address - Country:US
Practice Address - Phone:404-444-7160
Practice Address - Fax:404-996-2605
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-22
Last Update Date:2015-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAC 117171100000X
GAPT 7706225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA65BBCSDMedicare PIN