Provider Demographics
NPI:1457953507
Name:COOK, CASEY WILLIAM (LMP)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:WILLIAM
Last Name:COOK
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20141 COOK RD
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98233-4906
Mailing Address - Country:US
Mailing Address - Phone:360-854-8393
Mailing Address - Fax:
Practice Address - Street 1:20141 COOK RD
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98233-4906
Practice Address - Country:US
Practice Address - Phone:360-854-8393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-13
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00020452225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist