Provider Demographics
NPI:1154791085
Name:COOKE, JIL JONES (PT)
Entity type:Individual
Prefix:MRS
First Name:JIL
Middle Name:JONES
Last Name:COOKE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 E CURTIS ST
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29681-2622
Mailing Address - Country:US
Mailing Address - Phone:864-412-0711
Mailing Address - Fax:
Practice Address - Street 1:121 RIDGELEIGH WAY
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29681-6617
Practice Address - Country:US
Practice Address - Phone:864-962-1222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-05
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2117225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist