Provider Demographics
NPI:1992993406
Name:COOLEY, BENEDICT JOSEPH (PT)
Entity type:Individual
Prefix:
First Name:BENEDICT
Middle Name:JOSEPH
Last Name:COOLEY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31459 BARBEN RD
Mailing Address - Street 2:
Mailing Address - City:SEDRO WOOLLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98284-9160
Mailing Address - Country:US
Mailing Address - Phone:360-826-4827
Mailing Address - Fax:
Practice Address - Street 1:2225 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273-5403
Practice Address - Country:US
Practice Address - Phone:360-424-6226
Practice Address - Fax:360-424-0220
Is Sole Proprietor?:No
Enumeration Date:2007-10-10
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00010559225100000X
CAPT21736225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist