Healthcare Provider Details

I. General information

NPI: 1215769856
Provider Name (Legal Business Name): COOPER ALSPAUGH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2024
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4048 CEDAR BLUFF DR STE 2
PETOSKEY MI
49770-8895
US

IV. Provider business mailing address

11657 S FOREST HILL RD
EAGLE MI
48822-9722
US

V. Phone/Fax

Practice location:
  • Phone: 231-347-9300
  • Fax:
Mailing address:
  • Phone: 517-648-1551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501303486
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: