Provider Demographics
NPI:1407422900
Name:COOK, CHRISTINE LESLEY (CMT)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:LESLEY
Last Name:COOK
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 S FREMONT ST
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-3238
Mailing Address - Country:US
Mailing Address - Phone:415-606-2316
Mailing Address - Fax:
Practice Address - Street 1:7 S FREMONT ST
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-3238
Practice Address - Country:US
Practice Address - Phone:415-606-2316
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-03
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2283225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist