Provider Demographics
NPI:1891049839
Name:COOK, SCOTT LEE (ATC, EMT)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:LEE
Last Name:COOK
Suffix:
Gender:M
Credentials:ATC, EMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:128 GODWIN HL
Mailing Address - Street 2:MSC 2301
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22807-0001
Mailing Address - Country:US
Mailing Address - Phone:540-568-6576
Mailing Address - Fax:540-568-5351
Practice Address - Street 1:128 GODWIN HL
Practice Address - Street 2:MSC 2301
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22807-0001
Practice Address - Country:US
Practice Address - Phone:540-568-6576
Practice Address - Fax:540-568-5351
Is Sole Proprietor?:No
Enumeration Date:2012-10-30
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAB042016505146N00000X
VA01260006262255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic