Jesse Tyler Cook, DPT
Individual provider Active NPI Physical Therapist · Homedale, ID
NPI 1700330917 · NPPES record last updated Aug 5, 2016
Key facts
- NPI
- 1700330917
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- PT-4734 (ID)
- Practice address
- 134 E Idaho Ave
Homedale, ID 83628-5003 - Phone
- (208) 337-3254
- Fax
- (208) 337-3264
- NPI assigned
- Aug 5, 2016
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 2016
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Eagle Physical Therapy PA
Practice addresses (Care Compare)
457 S Fitness PL
Suite 100
Eagle, ID 83616-6568
Phone (208) 939-3332
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ID
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160908000985 | ID | Practitioner - Physical Therapist in Private Practice | 8022304641 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT-4734 | ID | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Eagle Physical Therapy PA | Physical Therapist | Current |
Accepting new patients |
Locations
457 S Fitness Pl
Ste 100
Eagle, ID 83616
Phone (208) 939-3332
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT-4734 | ID | Yes |
Addresses
Primary practice location
134 E Idaho Ave
Homedale, ID 83628-5003
Mailing address
1560 S Carol St
Meridian, ID 83646-1839
Phone (208) 287-9420
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PT-4734 | Other | ID | ID LICENSE |
Other providers in Homedale, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 5, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.