Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251P0200X | Physical Therapist - Pediatrics | A4492 | MD |
Y | 225200000X | Physical Therapy Assistant | 2133780 | TX |
N | 225200000X | Physical Therapy Assistant | A4492 | MD |
N | 225200000X | Physical Therapy Assistant | TEI005154 | PA |
N | 226300000X | Kinesiotherapist |
NPI | 1679926166 |
---|---|
Provider Name | Mr. Kevonte Cockrill |
First Address | Dallas, TX 75219-2371 |
Second Address | Dallas, TEXAS 75219 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2016 |
Last Update Date | 30/03/2021 |