=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730539214
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CATHERINE GRANT COOPER MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/15/2016
-----------------------------------------------------
Last Update Date | 09/10/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2835 FORT MISSOULA RD STE 204
-----------------------------------------------------
City | MISSOULA
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59804-7424
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-327-4308
-----------------------------------------------------
Fax | 406-327-3820
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1595 VALLEY WIND LN
-----------------------------------------------------
City | MISSOULA
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59804-5867
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-327-4308
-----------------------------------------------------
Fax | 406-327-3820
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208100000X
-----------------------------------------------------
Taxonomy Name | Physical Medicine & Rehabilitation Physician
-----------------------------------------------------
License Number | MED-PHYS-LIC-100643
-----------------------------------------------------
License Number State | MT
-----------------------------------------------------