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General NPI Number Information
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NPI Number | 1871804385
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Entity Type | Individual
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Provider Name | MICHAEL JAY COOPERMAN PT
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Gender | Male
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Dates
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Enumeration Date | 06/30/2010
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Last Update Date | 06/30/2010
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Provider Practice Location Address
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Address Line | 12717 S 28TH AVE
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City | BELLEVUE
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State | NE
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Zip | 68123-3232
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Country | US
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Telephone | 402-871-4089
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Fax |
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Provider Business Mailing Address
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Address Line | 1605 LEONA CIR
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City | BELLEVUE
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State | NE
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Zip | 68123-6806
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Country | US
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Telephone | 402-932-0712
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 2183
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License Number State | NE
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