Healthcare Provider Details

I. General information

NPI: 1669360103
Provider Name (Legal Business Name): COOPER A VALASEK RBT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2025
Last Update Date: 06/24/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10565 FAIRFAX BLVD STE 300
FAIRFAX VA
22030-3104
US

IV. Provider business mailing address

22781 SETTLERS TRAIL TER
BRAMBLETON VA
20148-6405
US

V. Phone/Fax

Practice location:
  • Phone: 703-218-6599
  • Fax:
Mailing address:
  • Phone: 808-255-7851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberBACB835107
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: