Individual
JONATHAN PATRICK COOK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BTL
Contact information
Practice address
1314 RIVERLAND RD SE, ROANOKE, VA 24014-3610
(866) 565-7222
(877) 734-1914
Mailing address
2 VILLAGE SQ STE 210, BALTIMORE, MD 21210-1624
(866) 565-7222
(877) 734-1914
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-23-257958
VA
Other
Enumeration date
07/13/2023
Last updated
02/29/2024
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