Provider Demographics
NPI:1104150481
Name:COOPER, AMY ELAINE (PTA)
Entity type:Individual
Prefix:MISS
First Name:AMY
Middle Name:ELAINE
Last Name:COOPER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:ELAINE
Other - Last Name:NUNNERY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:1619 EAGLE TRACE DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-7428
Mailing Address - Country:US
Mailing Address - Phone:615-773-5179
Mailing Address - Fax:
Practice Address - Street 1:4343 LEBANON PIKE
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076-1221
Practice Address - Country:US
Practice Address - Phone:615-871-8131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-20
Last Update Date:2009-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN870225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant