Basic Information
| Provider Information | |||||||||
| NPI: | 1295009199 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COOK | ||||||||
| FirstName: | JEFFREY | ||||||||
| MiddleName: | SCOTT | ||||||||
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| Credential: | DPT, OMPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2380 CEDAR ST. | ||||||||
| Address2: | SUITE 203 | ||||||||
| City: | HOLT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48842 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5177094677 | ||||||||
| FaxNumber: | 5177985667 | ||||||||
| Practice Location | |||||||||
| Address1: | 615 S CLINTON ST | ||||||||
| Address2: | |||||||||
| City: | GRAND LEDGE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488372355 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5177094677 | ||||||||
| FaxNumber: | 5178975667 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/24/2012 | ||||||||
| LastUpdateDate: | 08/18/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/18/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 5501015822 | MI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.