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General NPI Number Information
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NPI Number | 1376147991
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Entity Type | Individual
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Provider Name | CORY BECK DPT
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Gender | Male
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Dates
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Enumeration Date | 11/24/2020
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Last Update Date | 11/24/2020
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Provider Practice Location Address
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Address Line | 804 PANCHERI DR
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City | IDAHO FALLS
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State | ID
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Zip | 83402-3344
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Country | US
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Telephone | 208-206-0885
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Fax |
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Provider Business Mailing Address
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Address Line | 3840 SUMMERWOOD LN
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City | AMMON
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State | ID
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Zip | 83406-7539
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Country | US
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Telephone | 208-206-0885
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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 | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | PT-4407
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License Number State | ID
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