Healthcare Provider Details

I. General information

NPI: 1780508226
Provider Name (Legal Business Name): COOPER RYAN PORTER HEWES DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 FORD RD
JOHN DAY OR
97845-2009
US

IV. Provider business mailing address

162 OCEAN PINES TER
JUPITER FL
33477-9668
US

V. Phone/Fax

Practice location:
  • Phone: 541-575-4157
  • Fax:
Mailing address:
  • Phone: 224-678-5828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number66205
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT45198
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: