Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | PTA5194 | CA |
NPI | 1013488303 |
---|---|
Provider Name | Michelle A Cook |
First Address | Mission Viejo, CA 92692-4744 |
Second Address | Mission Viejo, CA 92691-5810 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/12/2018 |
Last Update Date | 11/12/2018 |