Basic Information
Provider Information | |||||||||
NPI: | 1265475529 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | COOKE | ||||||||
FirstName: | DEBRA | ||||||||
MiddleName: | ANN | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | PT | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | KEATING | ||||||||
OtherFirstName: | DEBRA | ||||||||
OtherMiddleName: | ANN | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | PT | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 981 US HIGHWAY 22 FL 2 | ||||||||
Address2: |   | ||||||||
City: | BRIDGEWATER | ||||||||
State: | NJ | ||||||||
PostalCode: | 088072946 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2018017141 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 1904 ATLANTIC AVE | ||||||||
Address2: |   | ||||||||
City: | MANASQUAN | ||||||||
State: | NJ | ||||||||
PostalCode: | 087361006 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7325281010 | ||||||||
FaxNumber: | 7325282139 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/14/2006 | ||||||||
LastUpdateDate: | 06/09/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 06/09/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2251X0800X | 40QA00896600 | NJ | N |   | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic | 225100000X | 40QA00896600 | NJ | Y |   | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |   |
ID Information
ID | Type | State | Issuer | Description | P00323751 | 01 | NJ | RR MEDICARE | OTHER |