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NPI Code Detail

MEDICARE: KELLY DAWN COOKE PT, DPT

MEDICARE: KELLY DAWN COOKE PT, 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 Therapist070021897IL

General Provider Information

NPI Number : 1831742204
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY DAWN COOKE PT, 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 : 227 N MARKET ST
Second Line :
City : PAXTON
State : IL
Zip : 60957-1123
Country : US
Telephone Number : 217-379-2500
Fax Number : 217-379-2554
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/24/2019
Last Update Date : 06/27/2024

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