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NPI Code Detail

MEDICARE: EILEEN COOKE PTA

MEDICARE: EILEEN COOKE 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 AssistantPTA11142CA

General Provider Information

NPI Number : 1871065268
Entity Type Code : Individual
Provider Name (Legal Business Name) : EILEEN COOKE PTA
Provider Business Mailing Address
First Line : 2424 CABRILLO AVE
Second Line :
City : TORRANCE
State : CA
Zip : 90501-4621
Country : US
Telephone Number : 213-422-2882
Fax Number :
Provider Business Practice Location Address
First Line : 3401 CEDAR AVE
Second Line :
City : LONG BEACH
State : CA
Zip : 90807-4422
Country : US
Telephone Number : 562-426-4461
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/22/2018
Last Update Date : 12/22/2018

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