Provider Demographics
NPI:1720287568
Name:CROOK, WANDA JK (PT)
Entity Type:Individual
Prefix:
First Name:WANDA
Middle Name:JK
Last Name:CROOK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16870 W BERNARDO DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-1677
Mailing Address - Country:US
Mailing Address - Phone:760-315-2599
Mailing Address - Fax:760-888-2499
Practice Address - Street 1:16870 W BERNARDO DR
Practice Address - Street 2:SUITE 400
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92127-1677
Practice Address - Country:US
Practice Address - Phone:760-315-2599
Practice Address - Fax:760-888-2499
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-12
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA145982251N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology