Provider Demographics
NPI:1174699292
Name:COOK, COLLEEN T (PT)
Entity type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:T
Last Name:COOK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:COLLEEN
Other - Middle Name:T
Other - Last Name:SHEA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:56 OLIVER ST
Mailing Address - Street 2:
Mailing Address - City:FAIRHAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02719-4820
Mailing Address - Country:US
Mailing Address - Phone:774-281-3828
Mailing Address - Fax:
Practice Address - Street 1:111 BREWSTER ST
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-4400
Practice Address - Country:US
Practice Address - Phone:401-729-2316
Practice Address - Fax:401-729-2680
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPT 02049225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist