Individual
MARK J COGLIANESE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MPT
Contact information
Practice address
217 N 2ND E, REXBURG, ID 83440-1621
(208) 359-6127
(208) 359-6127
Mailing address
544 GOLDEN WILLOW DR, REXBURG, ID 83440-5270
(084) 031-5052
(083) 596-1272
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
1375
NV
225100000X
Physical Therapist
Primary
PT-2916
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1912912791
—
ID
05
—
1912912791
—
NV
Enumeration date
07/30/2006
Last updated
12/19/2025
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