Healthcare Provider Details

I. General information

NPI: 1932067790
Provider Name (Legal Business Name): GLENDA COOK MT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2026
Last Update Date: 01/12/2026
Certification Date: 01/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 RICHIE LN STE B
SOMERSET KY
42503-6128
US

IV. Provider business mailing address

101 OAKDALE DR
SOMERSET KY
42503-9680
US

V. Phone/Fax

Practice location:
  • Phone: 606-492-0298
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number006083
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number287063
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: