Provider Demographics
NPI:1508603143
Name:COCHRANE, ERIC ALAN (PTA)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:ALAN
Last Name:COCHRANE
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7205 ROCK BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:GRAND LEDGE
Mailing Address - State:MI
Mailing Address - Zip Code:48837-9150
Mailing Address - Country:US
Mailing Address - Phone:517-719-8611
Mailing Address - Fax:
Practice Address - Street 1:15945 WOOD RD
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48906-1746
Practice Address - Country:US
Practice Address - Phone:517-719-8611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-11
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5502005594225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty