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NPI Code Detail

MEDICARE: MRS. LISA BETH COOPER PTA

MEDICARE: MRS. LISA BETH COOPER PTA
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
1225200000XPhysical Therapy Assistant7937MA

General Provider Information

NPI Number : 1417147232
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LISA BETH COOPER PTA
Provider Business Mailing Address
First Line : 140 CAPTAIN SAMADRUS RD
Second Line :
City : COTUIT
State : MA
Zip : 02635-2709
Country : US
Telephone Number : 508-428-9414
Fax Number : 508-428-9414
Provider Business Practice Location Address
First Line : 721 E FALMOUTH HWY
Second Line :
City : EAST FALMOUTH
State : MA
Zip : 02536-6191
Country : US
Telephone Number : 508-540-7609
Fax Number : 508-540-7539
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/27/2007
Last Update Date : 07/27/2007

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