MEDICARE: CHRISTY MARIE COOK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	MT.0018808	CO

General Provider Information

NPI Number	:	1376055848
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTY MARIE COOK

Provider Business Mailing Address
First Line	:	44 E SPAULDING AVE BUILDING 3 SUITE 3
Second Line	:
City	:	PUEBLO
State	:	CO
Zip	:	81007-1668
Country	:	US
Telephone Number	:	515-897-8824
Fax Number	:

Provider Business Practice Location Address
First Line	:	44 E SPAULDING AVE
Second Line	:	BLD 3 STE 3
City	:	PUEBLO
State	:	CO
Zip	:	81007-1668
Country	:	US
Telephone Number	:	515-897-8824
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2017
Last Update Date	:	01/31/2022

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Directions to “ CHRISTY MARIE COOK ” Practice Location

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