Provider Demographics
NPI:1306877592
Name:COOK, ROBERT JOHN (PT, MHS)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:JOHN
Last Name:COOK
Suffix:
Gender:M
Credentials:PT, MHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 SE 131ST AVE STE 205B
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-4013
Mailing Address - Country:US
Mailing Address - Phone:360-253-4767
Mailing Address - Fax:360-892-9241
Practice Address - Street 1:16500 SE 15TH ST
Practice Address - Street 2:STE 100
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-9666
Practice Address - Country:US
Practice Address - Phone:360-818-1101
Practice Address - Fax:888-842-6292
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT000082352251S0007X, 2251X0800X, 225000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAB37931Medicare ID - Type Unspecified