Provider Demographics
NPI:1750386892
Name:COX, DOUGLAS DELON (PT)
Entity type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:DELON
Last Name:COX
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1460
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:SD
Mailing Address - Zip Code:57402-1460
Mailing Address - Country:US
Mailing Address - Phone:605-753-0430
Mailing Address - Fax:605-753-2663
Practice Address - Street 1:701 8TH AVE NW
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401-1865
Practice Address - Country:US
Practice Address - Phone:605-226-2663
Practice Address - Fax:605-225-0351
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0381225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD1108470001Medicare NSC
SD436502Medicare Oscar/Certification
SD650014165Medicare PIN