Provider Demographics
NPI:1861571655
Name:COOK COUNTY THERAPY INC,
Entity type:Organization
Organization Name:COOK COUNTY THERAPY INC,
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:B
Authorized Official - Last Name:BETTS
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:229-896-2797
Mailing Address - Street 1:510 N PARRISH AVE
Mailing Address - Street 2:
Mailing Address - City:ADEL
Mailing Address - State:GA
Mailing Address - Zip Code:31620-2036
Mailing Address - Country:US
Mailing Address - Phone:229-896-2797
Mailing Address - Fax:229-896-1629
Practice Address - Street 1:510 N PARRISH AVE
Practice Address - Street 2:
Practice Address - City:ADEL
Practice Address - State:GA
Practice Address - Zip Code:31620-2036
Practice Address - Country:US
Practice Address - Phone:229-896-2797
Practice Address - Fax:229-896-1629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA00006976261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP6668Medicare ID - Type UnspecifiedPROVIDER #