Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | PT34445 | CA |
NPI | 1033343140 |
---|---|
Provider Name | Shirley Ann Cook |
First Address | Santa Rosa, CA 95401-4657 |
Second Address | Santa Rosa, CA 95401-4657 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2009 |
Last Update Date | 05/05/2009 |