Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter | PT00008235 | WA |
N | 2251S0007X | Physical Therapist - Sports | PT00008235 | WA |
N | 2251X0800X | Physical Therapist - Orthopedic | PT00008235 | WA |
NPI | 1306877592 |
---|---|
Provider Name | Robert John Cook |
First Address | Vancouver, WA 98683-4013 |
Second Address | Vancouver, WA 98683-9666 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2006 |
Last Update Date | 23/05/2016 |