MEDICARE: VERNON COOK

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1150150	OTHER	TX	LICENSE #

General Provider Information

NPI Number	:	1487667812
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VERNON COOK

Provider Business Mailing Address
First Line	:	7109 MAZY LN
Second Line	:
City	:	ROWLETT
State	:	TX
Zip	:	75089-1911
Country	:	US
Telephone Number	:	972-412-6709
Fax Number	:

Provider Business Practice Location Address
First Line	:	333 N SHILOH RD STE 108
Second Line	:
City	:	GARLAND
State	:	TX
Zip	:	75042-6613
Country	:	US
Telephone Number	:	972-276-0566
Fax Number	:

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

Provider Enumeration Date	:	08/15/2006
Last Update Date	:	07/08/2007

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Directions to “ VERNON COOK ” Practice Location

Language	Start Address	Practice Location

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