Healthcare Provider Details

I. General information

NPI: 1346595972
Provider Name (Legal Business Name): ELIAS COOK DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2012
Last Update Date: 07/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20730 BOND RD NE STE 206
POULSBO WA
98370-9000
US

IV. Provider business mailing address

8182 GRAYSTONE WAY NW
SILVERDALE WA
98383-7375
US

V. Phone/Fax

Practice location:
  • Phone: 360-779-3764
  • Fax:
Mailing address:
  • Phone: 509-999-4798
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number60281528
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: