Provider Demographics
NPI:1902131527
Name:COOK, AIMY CAROLINE (MHS, PT)
Entity Type:Individual
Prefix:MS
First Name:AIMY
Middle Name:CAROLINE
Last Name:COOK
Suffix:
Gender:F
Credentials:MHS, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 MEDINAH DR
Mailing Address - Street 2:
Mailing Address - City:EASLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29642-3128
Mailing Address - Country:US
Mailing Address - Phone:864-414-0496
Mailing Address - Fax:
Practice Address - Street 1:202 MEDINAH DR
Practice Address - Street 2:
Practice Address - City:EASLEY
Practice Address - State:SC
Practice Address - Zip Code:29642-3128
Practice Address - Country:US
Practice Address - Phone:864-414-0496
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-15
Last Update Date:2014-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3018225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1902131527Medicaid
SC1902131527Medicare UPIN
SC1902131527Medicare NSC
SC1902131527Medicaid
SC1902131527Medicare PIN