Healthcare Provider Details

I. General information

NPI: 1013420884
Provider Name (Legal Business Name): LAURA LEIGH COOPER DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2017
Last Update Date: 11/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9707 OLD GEORGETOWN RD
BETHESDA MD
20814-1745
US

IV. Provider business mailing address

113 COVERED BRIDGE LN
FRUITLAND MD
21826-1101
US

V. Phone/Fax

Practice location:
  • Phone: 301-530-0500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number26763
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: