Provider Demographics
NPI:1104516269
Name:COOPER PHYSICAL THERAPY PLLC
Entity type:Organization
Organization Name:COOPER PHYSICAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:R
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:909-709-8666
Mailing Address - Street 1:1 WEST ST APT 2820
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10004-1032
Mailing Address - Country:US
Mailing Address - Phone:909-709-8666
Mailing Address - Fax:
Practice Address - Street 1:122 W 26TH ST RM 701
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-6804
Practice Address - Country:US
Practice Address - Phone:646-801-8565
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-11
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy