Provider Demographics
NPI:1871533885
Name:COCHRAN, DONNA JEAN (PT)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:JEAN
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 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:
Practice Address - Street 1:217 N BROAD ST
Practice Address - Street 2:
Practice Address - City:GRIFFITH
Practice Address - State:IN
Practice Address - Zip Code:46319-2220
Practice Address - Country:US
Practice Address - Phone:219-924-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05007363A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000325387OtherANTHEM - 1ST AID PLUS
IN201055570Medicaid
IN000000324610OtherANTHEM - APT PLUS
IN000000324534OtherANTHEM - MBWOUDE
INP00212641Medicare ID - Type UnspecifiedRR MEDICARE
IN000000325387OtherANTHEM - 1ST AID PLUS