1306877592 NPI number — ROBERT JOHN COOK PT, MHS

Table of content: ROBERT JOHN COOK PT, MHS (NPI 1306877592)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306877592 NPI number — ROBERT JOHN COOK PT, MHS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COOK
Provider First Name:
ROBERT
Provider Middle Name:
JOHN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT, MHS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306877592
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/23/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
406 SE 131ST AVE STE 205B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VANCOUVER
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98683-4013
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-253-4767
Provider Business Mailing Address Fax Number:
360-892-9241

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16500 SE 15TH ST
Provider Second Line Business Practice Location Address:
STE 100
Provider Business Practice Location Address City Name:
VANCOUVER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98683-9666
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-818-1101
Provider Business Practice Location Address Fax Number:
888-842-6292
Provider Enumeration Date:
07/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2251S0007X , with the licence number:  PT00008235 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2251X0800X , with the licence number: PT00008235 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225000000X , with the licence number: PT00008235 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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