Healthcare Provider Details

I. General information

NPI: 1619130416
Provider Name (Legal Business Name): NATHAN BRUCE COOKE MS LAT ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2008
Last Update Date: 12/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

441 COUNTRY CLUB RD
YORK PA
17403-3651
US

IV. Provider business mailing address

441 COUNTRY CLUB RD
YORK PA
17403-3651
US

V. Phone/Fax

Practice location:
  • Phone: 717-815-1962
  • Fax: 717-849-1674
Mailing address:
  • Phone: 717-815-1962
  • Fax: 717-849-1674

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberRT002362A
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: