Basic Information
| Provider Information | |||||||||
| NPI: | 1447678933 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COOPER-SCOTT | ||||||||
| FirstName: | HALEY | ||||||||
| MiddleName: | |||||||||
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| Credential: | DPT, PT | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | COOPER | ||||||||
| OtherFirstName: | HALEY | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 8382 N WAYNE DR | ||||||||
| Address2: | |||||||||
| City: | HAYDEN | ||||||||
| State: | ID | ||||||||
| PostalCode: | 838356028 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2087580484 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 8382 N WAYNE DR | ||||||||
| Address2: | |||||||||
| City: | HAYDEN | ||||||||
| State: | ID | ||||||||
| PostalCode: | 838356028 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2087580484 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/01/2014 | ||||||||
| LastUpdateDate: | 04/01/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT-3505 | ID | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.