Provider Demographics
NPI:1144523101
Name:COOK, EARL GRAYSON (MSPT, OCS, CSCS)
Entity type:Individual
Prefix:
First Name:EARL
Middle Name:GRAYSON
Last Name:COOK
Suffix:
Gender:M
Credentials:MSPT, OCS, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1212 GARFIELD AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26101-3247
Mailing Address - Country:US
Mailing Address - Phone:304-865-6778
Mailing Address - Fax:304-865-7400
Practice Address - Street 1:47 DEPOT STREET
Practice Address - Street 2:
Practice Address - City:CHATHAM
Practice Address - State:VA
Practice Address - Zip Code:24531-3352
Practice Address - Country:US
Practice Address - Phone:434-432-0028
Practice Address - Fax:434-432-0062
Is Sole Proprietor?:No
Enumeration Date:2010-12-14
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305005400225100000X
NC4747225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAQ360689760Medicare PIN