Healthcare Provider Details

I. General information

NPI: 1356277354
Provider Name (Legal Business Name): ELIZABETH COOPER CMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 2231
RANCHO CUCAMONGA CA
91729-2231
US

IV. Provider business mailing address

PO BOX 2231
RANCHO CUCAMONGA CA
91729-2231
US

V. Phone/Fax

Practice location:
  • Phone: 909-638-2224
  • Fax:
Mailing address:
  • Phone: 909-638-2224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number102777
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: