Provider Demographics
NPI:1851388938
Name:COOK, MARK D (PT)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:D
Last Name:COOK
Suffix:
Gender:M
Credentials:PT
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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
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-04
Last Update Date:2007-09-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY010772 1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBB9460Medicare ID - Type Unspecified