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General NPI Number Information
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NPI Number | 1114831567
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Entity Type | Individual
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Provider Name | STEVEN EARL COOK LMT
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Gender | Male
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Dates
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Enumeration Date | 10/01/2026
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Last Update Date | 10/01/2026
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Provider Practice Location Address
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Address Line | 1515 ASHMENT AVE STE 2
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City | IDAHO FALLS
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State | ID
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Zip | 83404-5802
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Country | US
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Telephone | 208-881-9066
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Fax |
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Provider Business Mailing Address
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Address Line | 3390 OLSEN ST
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City | IONA
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State | ID
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Zip | 83427-5005
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Country | US
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Telephone | 208-251-2326
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MASG-815
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License Number State | ID
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