Basic Information
Provider Information
NPI: 1134281579
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: COOPER
FirstName: MURRAY
MiddleName: ANTHONY
NamePrefix:  
NameSuffix:  
Credential: P.T.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3001 EDWARDS MILL RD
Address2: 200
City: RALEIGH
State: NC
PostalCode: 276125243
CountryCode: US
TelephoneNumber: 9197814060
FaxNumber: 9197815246
Practice Location
Address1: 10880 DURANT RD
Address2: SUITE312
City: RALEIGH
State: NC
PostalCode: 276146628
CountryCode: US
TelephoneNumber: 9194635638
FaxNumber: 9194635639
Other Information
ProviderEnumerationDate: 12/14/2006
LastUpdateDate: 09/14/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000X5612NCY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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