Provider Demographics
NPI:1013488303
Name:COOK, MICHELLE A (PTA)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:A
Last Name:COOK
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:22866 HUNTER CRK
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92692-4744
Mailing Address - Country:US
Mailing Address - Phone:949-547-9535
Mailing Address - Fax:
Practice Address - Street 1:26932 OSO PKWY STE 260
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-5810
Practice Address - Country:US
Practice Address - Phone:949-582-8800
Practice Address - Fax:949-582-5127
Is Sole Proprietor?:No
Enumeration Date:2018-12-11
Last Update Date:2018-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPTA5194225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant