Provider Demographics
NPI:1043927650
Name:COOKE, LYDIA RUTH (MPT)
Entity Type:Individual
Prefix:MS
First Name:LYDIA
Middle Name:RUTH
Last Name:COOKE
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 FALLS GABLE LN APT H
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-5231
Mailing Address - Country:US
Mailing Address - Phone:410-913-3702
Mailing Address - Fax:
Practice Address - Street 1:2201 FALLS GABLE LN APT H
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21209-5231
Practice Address - Country:US
Practice Address - Phone:410-913-3702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-02
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17337225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty