Provider Demographics
NPI:1679910780
Name:COOK, JANIE (PT)
Entity type:Individual
Prefix:
First Name:JANIE
Middle Name:
Last Name:COOK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8257 TRADD CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-7297
Mailing Address - Country:US
Mailing Address - Phone:704-516-4364
Mailing Address - Fax:888-275-4154
Practice Address - Street 1:8257 TRADD CT
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-7297
Practice Address - Country:US
Practice Address - Phone:704-516-4364
Practice Address - Fax:888-275-4154
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-30
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC24182251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics