MEDICARE: GRETCHEN LEANNE COOPER PT

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	1073765	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8T5471	OTHER	TX	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134308752
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRETCHEN LEANNE COOPER PT

Provider Business Mailing Address
First Line	:	955 N CHARLOTTE AVE
Second Line	:
City	:	STEPHENVILLE
State	:	TX
Zip	:	76401-2003
Country	:	US
Telephone Number	:	254-965-8964
Fax Number	:

Provider Business Practice Location Address
First Line	:	955 N CHARLOTTE AVE
Second Line	:
City	:	STEPHENVILLE
State	:	TX
Zip	:	76401-2003
Country	:	US
Telephone Number	:	254-965-8964
Fax Number	:

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

Provider Enumeration Date	:	10/31/2007
Last Update Date	:	01/28/2026

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Directions to “ GRETCHEN LEANNE COOPER PT” Practice Location

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