Provider Demographics
NPI:1063748374
Name:COOKEECON, LLC
Entity type:Organization
Organization Name:COOKEECON, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:DAYNE
Authorized Official - Middle Name:ELLIOTT
Authorized Official - Last Name:CONLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PT, MPT, MS, SCS
Authorized Official - Phone:614-537-1005
Mailing Address - Street 1:154 W SCHROCK RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-4902
Mailing Address - Country:US
Mailing Address - Phone:614-791-8015
Mailing Address - Fax:614-794-3552
Practice Address - Street 1:700 W CHERRY ST
Practice Address - Street 2:
Practice Address - City:SUNBURY
Practice Address - State:OH
Practice Address - Zip Code:43074-8011
Practice Address - Country:US
Practice Address - Phone:614-791-8015
Practice Address - Fax:614-794-3552
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COOKEECON, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-10-20
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT - 008883225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty