=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558294843
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | COOPER THOMAS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/05/2026
-----------------------------------------------------
Last Update Date | 06/05/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3129 PERKINS RD
-----------------------------------------------------
City | BATON ROUGE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70808-2254
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 225-246-2076
-----------------------------------------------------
Fax | 225-246-2998
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4324 S SHERWOOD FOREST BLVD STE B170
-----------------------------------------------------
City | BATON ROUGE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70816-4481
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 225-654-8208
-----------------------------------------------------
Fax | 225-654-8208
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 12388
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------