| NPI | 1457083487 |
|---|---|
| Former Name | SHANNON TARA COOK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081P0010X Physical Medicine & Rehabilitation Pediatric Rehabilitation Medicine (Licence: ID PT-1900) |
| Additional Taxonomies | 261QP2000X Clinic/Center Physical Therapy (Licence: ID PT-1900) |
| Enumeration Date | 2022-06-28 |
| Last Update Date | 2024-10-01 |