Provider Demographics
NPI:1942224480
Name:COOK, DEBORAH SMICK (MS PT)
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:SMICK
Last Name:COOK
Suffix:
Gender:F
Credentials:MS PT
Other - Prefix:
Other - First Name:COOK
Other - Middle Name:RUTH
Other - Last Name:SMICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3 CALIENTE RD
Mailing Address - Street 2:UNIT 3-A
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87508-9209
Mailing Address - Country:US
Mailing Address - Phone:505-466-2500
Mailing Address - Fax:505-466-4959
Practice Address - Street 1:3 CALIENTE RD
Practice Address - Street 2:UNIT 3-A
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87508-9209
Practice Address - Country:US
Practice Address - Phone:505-466-2500
Practice Address - Fax:505-466-4959
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2044225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
342406202Medicare ID - Type Unspecified