Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 8766 | MA |
NPI | 1023001344 |
---|---|
Provider Name | Mr. Thomas Russell Cookson |
First Address | Peabody, MA 01960-3865 |
Second Address | Peabody, MA 01960-3865 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0358649 | (05) | MA |
2835244 | AETNA (01) | MA |
465520 | TUFTS (01) | MA |
626323 | HARVARD PILGRIM (01) | MA |
Y66951 | BLUE CROSS BLUE SHIELD (01) | MA |