Provider Demographics
NPI:1215075338
Name:COOPER, DEBRA F (PT)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:F
Last Name:COOPER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9170 BALSAMO DR
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33412-2484
Mailing Address - Country:US
Mailing Address - Phone:516-816-5291
Mailing Address - Fax:
Practice Address - Street 1:24 PHEASANT LN
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NY
Practice Address - Zip Code:11797-1926
Practice Address - Country:US
Practice Address - Phone:516-677-0808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL36729225100000X
NY014674-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist