Provider Demographics
NPI:1821086539
Name:COOK PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:COOK PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:D
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:315-329-7400
Mailing Address - Street 1:4305 MEDICAL CENTER DR
Mailing Address - Street 2:STE 4305
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13066-6638
Mailing Address - Country:US
Mailing Address - Phone:315-329-7400
Mailing Address - Fax:315-329-7403
Practice Address - Street 1:4305 MEDICAL CENTER DR
Practice Address - Street 2:STE 4305
Practice Address - City:FAYETTEVILLE
Practice Address - State:NY
Practice Address - Zip Code:13066-6638
Practice Address - Country:US
Practice Address - Phone:315-329-7400
Practice Address - Fax:315-329-7403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-07
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty