Provider Demographics
NPI:1285883645
Name:COOK, AMANDA JEAN (PT, DPT PT25782)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:JEAN
Last Name:COOK
Suffix:
Gender:F
Credentials:PT, DPT PT25782
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 18TH ST NE
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208-1428
Mailing Address - Country:US
Mailing Address - Phone:941-243-5811
Mailing Address - Fax:
Practice Address - Street 1:3260 LAKE POINTE BLVD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34231-6896
Practice Address - Country:US
Practice Address - Phone:941-929-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-10
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT 017096225100000X
FLPT25782225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist