Provider Demographics
NPI:1699219170
Name:COOPER, TONYA GAIL (PTA)
Entity type:Individual
Prefix:MISS
First Name:TONYA
Middle Name:GAIL
Last Name:COOPER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:428 E SCOTT AVE
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37917-6362
Mailing Address - Country:US
Mailing Address - Phone:865-318-1745
Mailing Address - Fax:
Practice Address - Street 1:211 CAMPUS LN
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37918-3202
Practice Address - Country:US
Practice Address - Phone:865-712-2522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-18
Last Update Date:2016-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPTA0000004876225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant