Provider Demographics
NPI:1992053201
Name:COOPER, CAITLIN MARGARET (PT)
Entity type:Individual
Prefix:MRS
First Name:CAITLIN
Middle Name:MARGARET
Last Name:COOPER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:CAITLIN
Other - Middle Name:MARGARET
Other - Last Name:NEWKIRK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:3908 VALLEY AVE
Mailing Address - Street 2:STE. B
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94566-4872
Mailing Address - Country:US
Mailing Address - Phone:925-417-8005
Mailing Address - Fax:925-417-8881
Practice Address - Street 1:3908 VALLEY AVE
Practice Address - Street 2:STE. B
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94566-4872
Practice Address - Country:US
Practice Address - Phone:925-417-8005
Practice Address - Fax:925-417-8881
Is Sole Proprietor?:No
Enumeration Date:2012-08-16
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT36700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT36700OtherCA PT LICENSE #