Provider Demographics
NPI:1215361548
Name:COOK, TIMOTHY EARL II (PTA)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:EARL
Last Name:COOK
Suffix:II
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 SUNCHASE BLVD
Mailing Address - Street 2:APT H
Mailing Address - City:FARMVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23901-2983
Mailing Address - Country:US
Mailing Address - Phone:304-416-0387
Mailing Address - Fax:
Practice Address - Street 1:2003 COBB ST
Practice Address - Street 2:THERAPY DEPARTMENT
Practice Address - City:FARMVILLE
Practice Address - State:VA
Practice Address - Zip Code:23901-2603
Practice Address - Country:US
Practice Address - Phone:434-392-6106
Practice Address - Fax:434-395-7095
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-22
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306602613225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant