Provider Demographics
NPI:1912201088
Name:COOK, DENISE (PTA, BCTMB)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:COOK
Suffix:
Gender:F
Credentials:PTA, BCTMB
Other - Prefix:
Other - First Name:DENISE
Other - Middle Name:
Other - Last Name:TOPEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8312 BLOOMINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-1726
Mailing Address - Country:US
Mailing Address - Phone:952-200-2330
Mailing Address - Fax:
Practice Address - Street 1:4450 ERIN DR STE 200C
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-2586
Practice Address - Country:US
Practice Address - Phone:952-200-2330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-04
Last Update Date:2023-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN225700000X
MNA2190225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist