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General NPI Number Information
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NPI Number | 1225727803
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Entity Type | Organization
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Legal Business Name | CAROLYN COOK WELLNESS LLC
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Dates
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Enumeration Date | 05/01/2023
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Last Update Date | 05/01/2023
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Provider Practice Location Address
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Address Line | 861 MONTAUK HWY
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City | BAYPORT
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State | NY
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Zip | 11705-1613
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Country | US
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Telephone | 631-472-1005
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Fax |
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Provider Business Mailing Address
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Address Line | 199 BELLPORT AVE
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City | MEDFORD
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State | NY
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Zip | 11763-2219
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Country | US
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Telephone | 631-741-0143
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Fax |
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Authorized Official
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Title or Position | SOLE MBR
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Name | CAROLYN MARIE COOK
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Credential | LMT
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Telephone | 631-741-0143
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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 |
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License Number State |
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