Healthcare Provider Details

I. General information

NPI: 1649308735
Provider Name (Legal Business Name): KYLE MICHAEL COOK MPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 07/12/2024
Certification Date: 07/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8192 S CASS AVE
DARIEN IL
60561
US

IV. Provider business mailing address

20632 S IVY PATH
FRANKFORT IL
60423-8742
US

V. Phone/Fax

Practice location:
  • Phone: 708-801-1005
  • Fax: 708-810-8686
Mailing address:
  • Phone: 763-360-1823
  • Fax: 708-810-8686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070.019705
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number070019705
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: