Healthcare Provider Details

I. General information

NPI: 1154843621
Provider Name (Legal Business Name): COOPER ALAN SAX ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2017
Last Update Date: 07/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 S HOMER ST
PITTSBURG KS
66762
US

IV. Provider business mailing address

714 E MONROE ST APT A
PITTSBURG KS
66762-6097
US

V. Phone/Fax

Practice location:
  • Phone: 913-832-0112
  • Fax:
Mailing address:
  • Phone: 913-832-0112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: