Basic Information
| Provider Information | |||||||||
| NPI: | 1588111470 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COOPER | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | JARED | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2531 ROCKY RIDGE RD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | VESTAVIA | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352434415 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2059787376 | ||||||||
| FaxNumber: | 2059780861 | ||||||||
| Practice Location | |||||||||
| Address1: | 2801 ALLISON BONNETT MEMORIAL DR | ||||||||
| Address2: | |||||||||
| City: | HUEYTOWN | ||||||||
| State: | AL | ||||||||
| PostalCode: | 350231859 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2055459905 | ||||||||
| FaxNumber: | 2055459969 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/08/2016 | ||||||||
| LastUpdateDate: | 09/08/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PTH8099 | AL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.