MEDICARE: NICHOLAS COOPER PT, DPT, PHD

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	2251X0800X	Orthopedic Physical Therapist	004178	IA
2	2251X0800X	Orthopedic Physical Therapist	070.026449	IL

General Provider Information

NPI Number	:	1851234785
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLAS COOPER PT, DPT, PHD

Provider Business Mailing Address
First Line	:	3900 28TH AVENUE DR
Second Line	:
City	:	MOLINE
State	:	IL
Zip	:	61265-5536
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3900 28TH AVENUE DR
Second Line	:
City	:	MOLINE
State	:	IL
Zip	:	61265-5536
Country	:	US
Telephone Number	:	309-281-2500
Fax Number	:

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

Provider Enumeration Date	:	04/14/2026
Last Update Date	:	04/14/2026

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