Provider Demographics
NPI:1831382183
Name:PATRICK J. COOLEY, D.C., P.T., P.C.
Entity type:Organization
Organization Name:PATRICK J. COOLEY, D.C., P.T., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:J
Authorized Official - Last Name:COOLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC, PT
Authorized Official - Phone:802-773-7700
Mailing Address - Street 1:71 ALLEN ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701-4570
Mailing Address - Country:US
Mailing Address - Phone:802-773-7700
Mailing Address - Fax:802-773-7720
Practice Address - Street 1:71 ALLEN ST
Practice Address - Street 2:SUITE 203
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-4570
Practice Address - Country:US
Practice Address - Phone:802-773-7700
Practice Address - Fax:802-773-7720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-21
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT68844 - PTOtherBLUE CROSS BLUE SHIELD
VTV169OtherCDPHP GROUP
GADE4922OtherRAILROAD MEDICARE-GROUP #
VT68845 - CHIROOtherBLUE CROSS BLUE SHIELD
VTVN3806Medicare PIN