Provider Demographics
NPI:1922888437
Name:COOK, SHEALENE J (LMT)
Entity Type:Individual
Prefix:MISS
First Name:SHEALENE
Middle Name:J
Last Name:COOK
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13413 RIVIERA BLVD
Mailing Address - Street 2:
Mailing Address - City:SNOHOMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98290-9766
Mailing Address - Country:US
Mailing Address - Phone:360-833-3310
Mailing Address - Fax:
Practice Address - Street 1:3131 SMOKEY POINT DR STE 5B
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-2301
Practice Address - Country:US
Practice Address - Phone:360-653-9600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA61433477225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist