MEDICARE: DAVID COOK PTA

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
1	225200000X	Physical Therapy Assistant	2057930	TX

General Provider Information

NPI Number	:	1114140449
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID COOK PTA

Provider Business Mailing Address
First Line	:	625 VERANDA CT APT 2144
Second Line	:
City	:	GRAND PRAIRIE
State	:	TX
Zip	:	75050-2388
Country	:	US
Telephone Number	:	512-968-9920
Fax Number	:

Provider Business Practice Location Address
First Line	:	7602 CULCOURT ST
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75209-3025
Country	:	US
Telephone Number	:	214-358-1162
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/11/2007
Last Update Date	:	07/08/2007

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Directions to “ DAVID COOK PTA” Practice Location

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