Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | J1-0002077 | DE |
N | 2251S0007X | Physical Therapist - Sports | J1-0002077 | DE |
N | 2251X0800X | Physical Therapist - Orthopedic | J1-0002077 | DE |
NPI | 1437182672 |
---|---|
Provider Name | Aaron Joesph Cooke |
First Address | Bolingbrook, IL 60440-4909 |
Second Address | Dover, DE 19904-4802 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2006 |
Last Update Date | 04/03/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
11590760 | CAQH (01) | |
1437182672 | (05) | DE |
2760814000 | IBC (01) | |
5070-0062 | CARE FIRST (01) | |
88760501 | NCA (01) |