Provider Demographics
NPI:1942099643
Name:COOK, LILLIAN MARTHA (DPT)
Entity type:Individual
Prefix:
First Name:LILLIAN
Middle Name:MARTHA
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 1:115 SUMNER RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-4758
Mailing Address - Country:US
Mailing Address - Phone:706-407-4446
Mailing Address - Fax:
Practice Address - Street 1:115 SUMNER RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-4758
Practice Address - Country:US
Practice Address - Phone:706-407-4446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-01
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist