Provider Demographics
NPI:1235588633
Name:COOK, MICHAEL (ATC, LAT, CSCS, CKTP)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:COOK
Suffix:
Gender:M
Credentials:ATC, LAT, CSCS, CKTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 LONGVIEW DR
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-2614
Mailing Address - Country:US
Mailing Address - Phone:978-578-4169
Mailing Address - Fax:978-524-0421
Practice Address - Street 1:12 LONGVIEW DR
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-2614
Practice Address - Country:US
Practice Address - Phone:978-578-4169
Practice Address - Fax:978-524-0421
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-07
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11582255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer