Provider Demographics
NPI:1003277450
Name:COOK, LACRAIG (RKT)
Entity Type:Individual
Prefix:
First Name:LACRAIG
Middle Name:
Last Name:COOK
Suffix:
Gender:M
Credentials:RKT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1410 BOBWHITE TRL
Mailing Address - Street 2:
Mailing Address - City:GLENN HEIGHTS
Mailing Address - State:TX
Mailing Address - Zip Code:75154-8446
Mailing Address - Country:US
Mailing Address - Phone:601-324-9793
Mailing Address - Fax:
Practice Address - Street 1:1410 BOBWHITE TRL
Practice Address - Street 2:
Practice Address - City:GLENN HEIGHTS
Practice Address - State:TX
Practice Address - Zip Code:75154-8446
Practice Address - Country:US
Practice Address - Phone:601-324-9793
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-14
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS800953163226300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes226300000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersKinesiotherapist