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General NPI Number Information
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NPI Number | 1245493345
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Entity Type | Individual
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Provider Name | CHRISTINE COOPER PTA
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Gender | Female
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Dates
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Enumeration Date | 07/08/2008
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Last Update Date | 07/08/2008
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Provider Practice Location Address
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Address Line | 4238 JAMES MADISON HIGHWAY
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City | FORK UNION
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State | VA
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Zip | 23055
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Country | US
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Telephone | 434-842-2916
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Fax |
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Provider Business Mailing Address
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Address Line | 1086 GEORGIA CREEK RD
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City | SCOTTSVILLE
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State | VA
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Zip | 24590-4591
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Country | US
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Telephone |
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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 | 2251G0304X
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Taxonomy Name | Geriatric Physical Therapist
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License Number | 2306602029
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License Number State | VA
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