Provider Demographics
NPI:1891970190
Name:COOK, RITA MICHELLE (PTA)
Entity Type:Individual
Prefix:MRS
First Name:RITA
Middle Name:MICHELLE
Last Name:COOK
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13848 SE CARLTON ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97236-4478
Mailing Address - Country:US
Mailing Address - Phone:503-762-0317
Mailing Address - Fax:
Practice Address - Street 1:13848 SE CARLTON ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97236-4478
Practice Address - Country:US
Practice Address - Phone:503-762-0317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-04
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR8086225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant