Healthcare Provider Details

I. General information

NPI: 1629596754
Provider Name (Legal Business Name): SUSAN MICHELLE COOK PT DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2017
Last Update Date: 09/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7000 W TANNERS CREEK DR
NORFOLK VA
23513-1151
US

IV. Provider business mailing address

302 BRIDLEWOOD LN
SUFFOLK VA
23434-2192
US

V. Phone/Fax

Practice location:
  • Phone: 757-852-4674
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number2305003987
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: