Individual
MRS. DEIDRA K COCKROFT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
130 PARKWAY PLZ, KOSCIUSKO, MS 39090-3217
(662) 289-3588
(662) 289-3533
Mailing address
PO BOX 23996, JACKSON, MS 39225-3996
(601) 206-6100
(601) 206-6052
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT1152
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01584323
—
MS
Enumeration date
04/11/2006
Last updated
03/31/2022
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