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NPI Code Detail

MEDICARE: JENNIFER LYNN COOPER P.T.

MEDICARE: JENNIFER LYNN COOPER P.T.
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
1225100000XPhysical TherapistPT 1642CA

General Provider Information

NPI Number : 1407806821
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER LYNN COOPER P.T.
Provider Business Mailing Address
First Line : 812 EMERALD BAY RD
Second Line :
City : S LAKE TAHOE
State : CA
Zip : 96150-6413
Country : US
Telephone Number : 530-542-2662
Fax Number : 530-542-2661
Provider Business Practice Location Address
First Line : 812 EMERALD BAY RD
Second Line :
City : SOUTH LAKE TAHOE
State : CA
Zip : 96150-6413
Country : US
Telephone Number : 530-542-2662
Fax Number : 530-542-2661
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/10/2006
Last Update Date : 01/25/2008

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