Provider Demographics
NPI:1396977922
Name:COOK, MARY ELIZABETH (MASSAGE THERAPIST)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ELIZABETH
Last Name:COOK
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 BENSON LN
Mailing Address - Street 2:
Mailing Address - City:REISTERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21136-5808
Mailing Address - Country:US
Mailing Address - Phone:443-802-8461
Mailing Address - Fax:
Practice Address - Street 1:408 MAIN ST
Practice Address - Street 2:
Practice Address - City:REISTERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21136-1995
Practice Address - Country:US
Practice Address - Phone:443-802-8461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-15
Last Update Date:2009-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDM00149225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist