Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 0556 | MO |
N | 2251N0400X | Physical Therapist - Neurology | 11-02878 | KS |
NPI | 1326134347 |
---|---|
Provider Name | Deborah Lee Cooke |
First Address | Kansas City, MO 64111 |
Second Address | Kansas City, MO 64111-2658 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
32911028 | BLUE CROSS BLUE SHIELD (01) | MO |
399054 | BLUE CROSS BLUE SHIELD (01) | KS |