Provider Demographics
NPI:1740610781
Name:COOK, RONNIE TRAVIS (PTA)
Entity Type:Individual
Prefix:
First Name:RONNIE
Middle Name:TRAVIS
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 1:5773 HIGHWAY 510
Mailing Address - Street 2:
Mailing Address - City:GORDON
Mailing Address - State:KY
Mailing Address - Zip Code:41819-8941
Mailing Address - Country:US
Mailing Address - Phone:606-505-0020
Mailing Address - Fax:
Practice Address - Street 1:5773 HIGHWAY 510
Practice Address - Street 2:
Practice Address - City:GORDON
Practice Address - State:KY
Practice Address - Zip Code:41819-8941
Practice Address - Country:US
Practice Address - Phone:606-505-0020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-12
Last Update Date:2013-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYA03025225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant