Healthcare Provider Details

I. General information

NPI: 1558294843
Provider Name (Legal Business Name): COOPER THOMAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3129 PERKINS RD
BATON ROUGE LA
70808-2254
US

IV. Provider business mailing address

4324 S SHERWOOD FOREST BLVD STE B170
BATON ROUGE LA
70816-4481
US

V. Phone/Fax

Practice location:
  • Phone: 225-246-2076
  • Fax: 225-246-2998
Mailing address:
  • Phone: 225-654-8208
  • Fax: 225-654-8208

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number12388
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: