Provider Demographics
NPI:1336455278
Name:COOK, KEVIN BRINTON
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:BRINTON
Last Name:COOK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11225 PLAYA CARIBE AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89138-1512
Mailing Address - Country:US
Mailing Address - Phone:702-596-6940
Mailing Address - Fax:702-989-4669
Practice Address - Street 1:11225 PLAYA CARIBE AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89138-1512
Practice Address - Country:US
Practice Address - Phone:702-596-6940
Practice Address - Fax:702-989-4669
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-30
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner