MEDICARE: KRISTOFER COOPER

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	5501013004	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5501013004	OTHER	MI	LICENSE

General Provider Information

NPI Number	:	1932217627
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTOFER COOPER

Provider Business Mailing Address
First Line	:	6400 W MAIN ST STE C
Second Line	:
City	:	KALAMAZOO
State	:	MI
Zip	:	49009-9272
Country	:	US
Telephone Number	:	269-372-1027
Fax Number	:

Provider Business Practice Location Address
First Line	:	6400 W MAIN ST STE C
Second Line	:
City	:	KALAMAZOO
State	:	MI
Zip	:	49009-9272
Country	:	US
Telephone Number	:	269-372-1027
Fax Number	:

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

Provider Enumeration Date	:	08/25/2006
Last Update Date	:	12/05/2025

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Directions to “ KRISTOFER COOPER ” Practice Location

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