Healthcare Provider Details

I. General information

NPI: 1508603143
Provider Name (Legal Business Name): ERIC ALAN COCHRANE PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2024
Last Update Date: 07/11/2024
Certification Date: 07/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15945 WOOD RD
LANSING MI
48906-1746
US

IV. Provider business mailing address

7205 ROCK BRIDGE RD
GRAND LEDGE MI
48837-9150
US

V. Phone/Fax

Practice location:
  • Phone: 517-719-8611
  • Fax:
Mailing address:
  • Phone: 517-719-8611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number5502005594
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: