MEDICARE: BRIDGET COOL ATC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer	0126002727	VA
2	2255A2300X	Athletic Trainer	AL6555	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	22	OTHER		22

General Provider Information

NPI Number	:	1265082903
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIDGET COOL ATC

Provider Business Mailing Address
First Line	:	1036 SUNNYSIDE DR
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-1931
Country	:	US
Telephone Number	:	757-536-2298
Fax Number	:

Provider Business Practice Location Address
First Line	:	1924 LANDSTOWN CENTRE WAY
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23456-1624
Country	:	US
Telephone Number	:	757-536-2298
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/15/2019
Last Update Date	:	04/03/2025

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Directions to “ BRIDGET COOL ATC” Practice Location

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