Provider Demographics
NPI:1487022547
Name:COOK, ADAM HEATH (ATC)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:HEATH
Last Name:COOK
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:163 PINEVILLA DR
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-9358
Mailing Address - Country:US
Mailing Address - Phone:304-673-3548
Mailing Address - Fax:
Practice Address - Street 1:9 YELLOW WOOD WAY
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-7126
Practice Address - Country:US
Practice Address - Phone:304-255-2376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-07
Last Update Date:2015-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVAT0013572255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer