Provider Demographics
NPI:1457114902
Name:COOK, LYSIA ROSE (DPT)
Entity Type:Individual
Prefix:
First Name:LYSIA
Middle Name:ROSE
Last Name:COOK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 SHADY AVE APT C4
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15206-4478
Mailing Address - Country:US
Mailing Address - Phone:216-618-1248
Mailing Address - Fax:
Practice Address - Street 1:2870 TALLEY CAVEY RD STE 100
Practice Address - Street 2:
Practice Address - City:ALLISON PARK
Practice Address - State:PA
Practice Address - Zip Code:15101-2450
Practice Address - Country:US
Practice Address - Phone:412-487-2787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-06
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT032024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist