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NPI Code Detail

MEDICARE: LISA LORRAINE COOK PTA

MEDICARE: LISA LORRAINE 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
1225200000XPhysical Therapy Assistant06000350AIN

General Provider Information

NPI Number : 1235346289
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA LORRAINE COOK PTA
Provider Business Mailing Address
First Line : 8305 SCHAEFFER RD
Second Line :
City : EVANSVILLE
State : IN
Zip : 47720-7492
Country : US
Telephone Number : 812-963-0993
Fax Number :
Provider Business Practice Location Address
First Line : 2819 N SAINT JOSEPH AVE
Second Line :
City : EVANSVILLE
State : IN
Zip : 47720-1335
Country : US
Telephone Number : 812-424-2941
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/17/2007
Last Update Date : 07/08/2007

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Directions to “ LISA LORRAINE COOK PTA” Practice Location

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