Healthcare Provider Details

I. General information

NPI: 1851234785
Provider Name (Legal Business Name): NICHOLAS COOPER PT, DPT, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2026
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 28TH AVENUE DR
MOLINE IL
61265-5536
US

IV. Provider business mailing address

3900 28TH AVENUE DR
MOLINE IL
61265-5536
US

V. Phone/Fax

Practice location:
  • Phone: 309-281-2500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number004178
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number070.026449
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: