Provider Demographics
NPI:1730303876
Name:COOK, KARLA ELIZABETH (PTA, ATC)
Entity Type:Individual
Prefix:
First Name:KARLA
Middle Name:ELIZABETH
Last Name:COOK
Suffix:
Gender:F
Credentials:PTA, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 NANDINA ST
Mailing Address - Street 2:
Mailing Address - City:SWEET HOME
Mailing Address - State:OR
Mailing Address - Zip Code:97386-1522
Mailing Address - Country:US
Mailing Address - Phone:541-367-2191
Mailing Address - Fax:541-367-2630
Practice Address - Street 1:950 NANDINA ST
Practice Address - Street 2:
Practice Address - City:SWEET HOME
Practice Address - State:OR
Practice Address - Zip Code:97386-1522
Practice Address - Country:US
Practice Address - Phone:541-367-2191
Practice Address - Fax:541-367-2630
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAT-AT-10071062255A2300X
OR8775225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer