Healthcare Provider Details

I. General information

NPI: 1306877592
Provider Name (Legal Business Name): ROBERT JOHN COOK PT, MHS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 05/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16500 SE 15TH ST STE 100
VANCOUVER WA
98683-9666
US

IV. Provider business mailing address

406 SE 131ST AVE STE 205B
VANCOUVER WA
98683-4013
US

V. Phone/Fax

Practice location:
  • Phone: 360-818-1101
  • Fax: 888-842-6292
Mailing address:
  • Phone: 360-253-4767
  • Fax: 360-892-9241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License NumberPT00008235
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT00008235
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License NumberPT00008235
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: