Provider Demographics
NPI:1932389269
Name:COOPER, KELLI (PT, DPT, NCS)
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:
Last Name:COOPER
Suffix:
Gender:F
Credentials:PT, DPT, NCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:936 S 1500 E
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84105-1639
Mailing Address - Country:US
Mailing Address - Phone:801-633-2644
Mailing Address - Fax:
Practice Address - Street 1:936 S 1500 E
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84105-1639
Practice Address - Country:US
Practice Address - Phone:801-633-2644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-03
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT657117924012251N0400X
TX11968372251N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology