Provider Demographics
NPI:1649308735
Name:COOK, KYLE MICHAEL (MPT)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:MICHAEL
Last Name:COOK
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20632 S IVY PATH
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423-8742
Mailing Address - Country:US
Mailing Address - Phone:763-360-1823
Mailing Address - Fax:708-810-8686
Practice Address - Street 1:8192 S CASS AVE
Practice Address - Street 2:
Practice Address - City:DARIEN
Practice Address - State:IL
Practice Address - Zip Code:60561
Practice Address - Country:US
Practice Address - Phone:708-801-1005
Practice Address - Fax:708-810-8686
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0700197052251X0800X
IL070.019705225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
12524408OtherCAQH