Individual
TONY GARRETT COOK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCP
Contact information
Practice address
610 W MAIN ST, STE E, CAMPBELLSVILLE, KY 42718-2501
(270) 465-8522
(270) 465-8523
Mailing address
610 W MAIN ST, STE E, CAMPBELLSVILLE, KY 42718-2501
(270) 465-8522
(270) 465-8523
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
LP132
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000788517
ATHEM BLUE CROSS AND BLUE SHIELD
KY
05
—
7100209830
—
KY
Enumeration date
11/16/2009
Last updated
12/03/2012
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