Provider Demographics
NPI:1740321637
Name:COKELEY, TRACY L (MPT)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:L
Last Name:COKELEY
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:L
Other - Last Name:WILHELM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:625 ENTERPRISE DR
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-8813
Mailing Address - Country:US
Mailing Address - Phone:630-575-6250
Mailing Address - Fax:630-575-7450
Practice Address - Street 1:990 ELK GROVE TOWN CTR
Practice Address - Street 2:
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007-3754
Practice Address - Country:US
Practice Address - Phone:847-290-1111
Practice Address - Fax:847-290-1065
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070013704225100000X
TN10054225100000X
MS5623225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist