Healthcare Provider Details

I. General information

NPI: 1245493345
Provider Name (Legal Business Name): CHRISTINE COOPER PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2008
Last Update Date: 07/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4238 JAMES MADISON HIGHWAY
FORK UNION VA
23055
US

IV. Provider business mailing address

1086 GEORGIA CREEK RD
SCOTTSVILLE VA
24590-4591
US

V. Phone/Fax

Practice location:
  • Phone: 434-842-2916
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number2306602029
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: