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General NPI Number Information
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NPI Number | 1174721047
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Entity Type | Individual
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Provider Name | KIMBERLY GARRETT COOPER RPT
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Gender | Female
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Dates
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Enumeration Date | 07/03/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 112 RIVERBEND CV
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City | BRANDON
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State | MS
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Zip | 39047-8647
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Country | US
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Telephone | 601-825-9501
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Fax |
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Provider Business Mailing Address
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Address Line | 112 RIVERBEND CV
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City | BRANDON
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State | MS
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Zip | 39047-8647
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Country | US
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Telephone | 601-825-9501
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number | PT0196
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License Number State | MS
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