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Individual

MR. MARK STEVEN COOK

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
P.T.

Contact information

Practice address
945 WILDWOOD RD, WHITE BEAR LAKE, MN 55115-1847
(651) 770-0176
Mailing address
2595 MAYFAIR AVE, WHITE BEAR LAKE, MN 55110-4960
(651) 238-0512

Taxonomy

Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
6202
MN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
6202
LICENSE NUMBER
MN
Enumeration date
04/18/2007
Last updated
07/08/2007
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