Provider Demographics
NPI:1497993760
Name:COOK, LISA S (MA)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:S
Last Name:COOK
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5023 PECO RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-3468
Mailing Address - Country:US
Mailing Address - Phone:704-995-2900
Mailing Address - Fax:704-846-2958
Practice Address - Street 1:5023 PECO RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-3468
Practice Address - Country:US
Practice Address - Phone:704-995-2900
Practice Address - Fax:704-846-2958
Is Sole Proprietor?:No
Enumeration Date:2009-01-26
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist