Provider Demographics
NPI:1306511902
Name:COOPER, ANDREA (CTRS)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:COOPER
Suffix:
Gender:M
Credentials:CTRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9472 CENTERWAY DR
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-7404
Mailing Address - Country:US
Mailing Address - Phone:210-387-2046
Mailing Address - Fax:
Practice Address - Street 1:9472 CENTERWAY DR
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23059-7404
Practice Address - Country:US
Practice Address - Phone:210-387-2046
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-16
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist