Healthcare Provider Details

I. General information

NPI: 1487437042
Provider Name (Legal Business Name): GRACE MARIE COOK DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2023
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5959 BIG TREE RD STE 108
ORCHARD PARK NY
14127-2291
US

IV. Provider business mailing address

4225 GENESEE ST STE 400
CHEEKTOWAGA NY
14225-1994
US

V. Phone/Fax

Practice location:
  • Phone: 716-204-3200
  • Fax: 716-204-4337
Mailing address:
  • Phone: 716-204-3200
  • Fax: 716-204-4337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number050885
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number20816
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: