Provider Demographics
NPI:1093234809
Name:COOK, CARISSA AMBER (PTA)
Entity Type:Individual
Prefix:
First Name:CARISSA
Middle Name:AMBER
Last Name:COOK
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4624 E 43RD ST
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72117-2648
Mailing Address - Country:US
Mailing Address - Phone:501-319-7659
Mailing Address - Fax:501-353-2781
Practice Address - Street 1:4624 E 43RD ST
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72117-2648
Practice Address - Country:US
Practice Address - Phone:501-319-7659
Practice Address - Fax:501-353-2781
Is Sole Proprietor?:No
Enumeration Date:2017-09-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPTA4214225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant