MEDICARE: TINA L. 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
1	225100000X	Physical Therapist	5501013891	MI
2	225100000X	Physical Therapist	PTL-10205	CO

General Provider Information

NPI Number	:	1437302726
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TINA L. COOK DPT

Provider Business Mailing Address
First Line	:	600 S 21ST ST
Second Line	:	SUITE 130
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80904-3762
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	600 S 21ST ST
Second Line	:	SUITE 130
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80904-3762
Country	:	US
Telephone Number	:	719-634-1110
Fax Number	:	719-634-1112

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

Provider Enumeration Date	:	10/30/2008
Last Update Date	:	03/03/2011

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Directions to “ TINA L. COOK DPT” Practice Location

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