Provider Demographics
NPI:1750972535
Name:COOK, SHELBY LYNN (PTA)
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:LYNN
Last Name:COOK
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:243 UNION ST
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42501-2412
Mailing Address - Country:US
Mailing Address - Phone:606-425-4665
Mailing Address - Fax:606-678-0333
Practice Address - Street 1:243 UNION ST
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42501-2412
Practice Address - Country:US
Practice Address - Phone:606-425-4665
Practice Address - Fax:606-678-0333
Is Sole Proprietor?:No
Enumeration Date:2021-02-03
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYA04168225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant