Provider Demographics
NPI:1801060132
Name:BAKIS COOK, KRISTEN E (PT)
Entity type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:E
Last Name:BAKIS COOK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:KRISTEN
Other - Middle Name:E
Other - Last Name:COOK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:18 LEAH ST
Mailing Address - Street 2:
Mailing Address - City:MELROSE
Mailing Address - State:MA
Mailing Address - Zip Code:02176-4912
Mailing Address - Country:US
Mailing Address - Phone:617-943-2285
Mailing Address - Fax:
Practice Address - Street 1:18 LEAH ST
Practice Address - Street 2:
Practice Address - City:MELROSE
Practice Address - State:MA
Practice Address - Zip Code:02176-4912
Practice Address - Country:US
Practice Address - Phone:617-943-2285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-17
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11489225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist