Healthcare Provider Details

I. General information

NPI: 1396654448
Provider Name (Legal Business Name): WALI ABDUL COOPER II
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 SOUTHPARK MALL
COLONIAL HEIGHTS VA
23834-2962
US

IV. Provider business mailing address

45 COLONIAL CT
COLONIAL HEIGHTS VA
23834-3163
US

V. Phone/Fax

Practice location:
  • Phone: 267-596-6607
  • Fax:
Mailing address:
  • Phone: 267-596-6607
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License NumberHCO0006201
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: