Provider Demographics
NPI:1477802049
Name:COX, MICHAEL JASON (PT)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JASON
Last Name:COX
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9108 SURREY RD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-6802
Mailing Address - Country:US
Mailing Address - Phone:505-948-4555
Mailing Address - Fax:505-761-0025
Practice Address - Street 1:5971 JEFFERSON ST NE
Practice Address - Street 2:SUITE 102
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-3455
Practice Address - Country:US
Practice Address - Phone:505-948-4555
Practice Address - Fax:505-761-0025
Is Sole Proprietor?:No
Enumeration Date:2012-08-29
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4204225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM63189372Medicaid
NM63189372Medicaid