Provider Demographics
NPI:1598914848
Name:COOK, TIM (PTA)
Entity Type:Individual
Prefix:MR
First Name:TIM
Middle Name:
Last Name:COOK
Suffix:
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 1:2300 WATKINS LAKE RD
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48328-1439
Mailing Address - Country:US
Mailing Address - Phone:248-674-2241
Mailing Address - Fax:248-618-8085
Practice Address - Street 1:2300 WATKINS LAKE RD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48328-1439
Practice Address - Country:US
Practice Address - Phone:248-674-2241
Practice Address - Fax:248-618-8085
Is Sole Proprietor?:No
Enumeration Date:2008-09-11
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant