MEDICARE: HALEY COOPER-SCOTT DPT, PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT-3505	ID

General Provider Information

NPI Number	:	1447678933
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HALEY COOPER-SCOTT DPT, PT

Provider Business Mailing Address
First Line	:	8382 N WAYNE DR
Second Line	:
City	:	HAYDEN
State	:	ID
Zip	:	83835-6028
Country	:	US
Telephone Number	:	208-758-0484
Fax Number	:

Provider Business Practice Location Address
First Line	:	8382 N WAYNE DR
Second Line	:
City	:	HAYDEN
State	:	ID
Zip	:	83835-6028
Country	:	US
Telephone Number	:	208-758-0484
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/01/2014
Last Update Date	:	04/01/2014

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