Provider Demographics
NPI:1659315778
Name:COOK, MATTHEW C (ATC)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:C
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 1:400 NORTH ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SACO
Mailing Address - State:ME
Mailing Address - Zip Code:04072-1867
Mailing Address - Country:US
Mailing Address - Phone:207-282-7121
Mailing Address - Fax:207-282-0073
Practice Address - Street 1:400 NORTH ST
Practice Address - Street 2:SUITE 2
Practice Address - City:SACO
Practice Address - State:ME
Practice Address - Zip Code:04072-1867
Practice Address - Country:US
Practice Address - Phone:207-282-7121
Practice Address - Fax:207-282-0073
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAT1162255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer