Individual
JESSE TYLER COOK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
134 E IDAHO AVE, HOMEDALE, ID 83628-5003
(208) 337-3254
(208) 337-3264
Mailing address
1560 S CAROL ST, MERIDIAN, ID 83646-1839
(208) 287-9420
(208) 287-9426
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT-4734
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PT-4734
ID LICENSE
ID
Enumeration date
08/05/2016
Last updated
08/05/2016
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