Provider Demographics
NPI:1912214735
Name:COOKE, BAILEY (PTA)
Entity Type:Individual
Prefix:
First Name:BAILEY
Middle Name:
Last Name:COOKE
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 1:5000 BLUE MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59804-9213
Mailing Address - Country:US
Mailing Address - Phone:406-251-2323
Mailing Address - Fax:406-251-2999
Practice Address - Street 1:5000 BLUE MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59804-9213
Practice Address - Country:US
Practice Address - Phone:406-251-2323
Practice Address - Fax:406-251-2999
Is Sole Proprietor?:No
Enumeration Date:2010-09-01
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT2363PTA225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1306858642OtherORGANIZATION NPI