=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770461634
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PEYTON BRICE COOPER PT, DPT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/26/2025
-----------------------------------------------------
Last Update Date | 08/26/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2060 RHINO XING
-----------------------------------------------------
City | MILAN
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38358-5201
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 731-613-2214
-----------------------------------------------------
Fax | 731-613-2215
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 404 BELAIR DR
-----------------------------------------------------
City | GREENFIELD
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38230-1224
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 731-514-2805
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
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 | 16634
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------