Provider Demographics
NPI:1306415526
Name:COCHRAN, NICOLE DEAN (PT)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:DEAN
Last Name:COCHRAN
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 1:2930 S MERIDIAN STE 120
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-1654
Mailing Address - Country:US
Mailing Address - Phone:253-445-2733
Mailing Address - Fax:253-445-2399
Practice Address - Street 1:2930 S MERIDIAN STE 120
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-1654
Practice Address - Country:US
Practice Address - Phone:253-445-2733
Practice Address - Fax:253-445-2399
Is Sole Proprietor?:No
Enumeration Date:2021-06-22
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61171535225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist