Provider Demographics
NPI:1265540934
Name:COOK, SERENA (PT, CEAS)
Entity type:Individual
Prefix:
First Name:SERENA
Middle Name:
Last Name:COOK
Suffix:
Gender:F
Credentials:PT, CEAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4623 PILGRIM TRL
Mailing Address - Street 2:
Mailing Address - City:MOLINO
Mailing Address - State:FL
Mailing Address - Zip Code:32577-9541
Mailing Address - Country:US
Mailing Address - Phone:850-449-6240
Mailing Address - Fax:
Practice Address - Street 1:14114 ALABAMA ST
Practice Address - Street 2:
Practice Address - City:JAY
Practice Address - State:FL
Practice Address - Zip Code:32565-1219
Practice Address - Country:US
Practice Address - Phone:448-227-5840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALPTH 4688OtherALABAMA LICENSE NUMBER
FLPT 14796OtherLICENSE #