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NPI Code Detail

MEDICARE: BRADEN FOREST COOK DPT

MEDICARE: BRADEN FOREST COOK DPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical TherapistAZ
2225100000XPhysical TherapistVA

General Provider Information

NPI Number : 1033818190
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRADEN FOREST COOK DPT
Provider Business Mailing Address
First Line : 790 REMINGTON BLVD
Second Line :
City : BOLINGBROOK
State : IL
Zip : 60440-4909
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5977 E GRANT RD STE 101
Second Line :
City : TUCSON
State : AZ
Zip : 85712-2369
Country : US
Telephone Number : 520-448-5700
Fax Number : 520-822-8641
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/27/2023
Last Update Date : 01/12/2024

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Directions to “ BRADEN FOREST COOK DPT” Practice Location

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