Provider Demographics
NPI:1043294515
Name:COOK, JEREMY (PT)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:
Last Name:COOK
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 1:325 W MORRIS BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37813-2237
Mailing Address - Country:US
Mailing Address - Phone:423-317-7772
Mailing Address - Fax:423-317-7773
Practice Address - Street 1:900 W MAIN ST
Practice Address - Street 2:
Practice Address - City:ROGERSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37857-2448
Practice Address - Country:US
Practice Address - Phone:423-500-5600
Practice Address - Fax:423-317-7773
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020692-1225100000X
TN16178225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ098770Medicaid
NY02237709Medicaid