Healthcare Provider Details

I. General information

NPI: 1396136495
Provider Name (Legal Business Name): JOSHUA COOPER PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2015
Last Update Date: 02/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 SE 17TH ST STE 300
OCALA FL
34471-3968
US

IV. Provider business mailing address

1015 SE 17TH ST STE 300
OCALA FL
34471-3968
US

V. Phone/Fax

Practice location:
  • Phone: 352-693-3378
  • Fax:
Mailing address:
  • Phone: 352-693-3378
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number30090
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: