Provider Demographics
NPI:1881602076
Name:COOKE, CHAD A (ATC/L)
Entity type:Individual
Prefix:MR
First Name:CHAD
Middle Name:A
Last Name:COOKE
Suffix:
Gender:M
Credentials:ATC/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4303 HASTINGS CT E
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22408-7707
Mailing Address - Country:US
Mailing Address - Phone:540-907-8764
Mailing Address - Fax:
Practice Address - Street 1:2135 MOUNTAIN VIEW RD
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22556-6411
Practice Address - Country:US
Practice Address - Phone:540-658-6840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer