MEDICARE: MRS. NADIA MADELINE COOPER PT, DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	17529	MA
2	225100000X	Physical Therapist	37955	CA

General Provider Information

NPI Number	:	1003993692
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NADIA MADELINE COOPER PT, DPT

Provider Business Mailing Address
First Line	:	1418 CEDARWOOD DR
Second Line	:
City	:	SAN MATEO
State	:	CA
Zip	:	94403-3911
Country	:	US
Telephone Number	:	617-460-1667
Fax Number	:

Provider Business Practice Location Address
First Line	:	1400 VETERANS BLVD
Second Line	:
City	:	REDWOOD CITY
State	:	CA
Zip	:	94063-2612
Country	:	US
Telephone Number	:	650-299-6053
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	01/03/2022

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