Healthcare Provider Details

I. General information

NPI: 1730621657
Provider Name (Legal Business Name): ANTHONY ROBERT COCHRAN PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2016
Last Update Date: 01/15/2024
Certification Date: 01/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 LAKE JOY RD STE D
KATHLEEN GA
31047-2382
US

IV. Provider business mailing address

1200 CORPORATE DR STE 400
HOOVER AL
35242-5424
US

V. Phone/Fax

Practice location:
  • Phone: 478-313-5385
  • Fax: 478-313-5429
Mailing address:
  • Phone: 866-518-0283
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT012698
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: