Provider Demographics
NPI:1003160748
Name:COOPER, PERRY (LAC)
Entity Type:Individual
Prefix:MR
First Name:PERRY
Middle Name:
Last Name:COOPER
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:16601 N 40TH ST
Mailing Address - Street 2:SUITE 125
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-3345
Mailing Address - Country:US
Mailing Address - Phone:480-559-9744
Mailing Address - Fax:480-559-9784
Practice Address - Street 1:16601 N 40TH ST
Practice Address - Street 2:SUITE 125
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-3345
Practice Address - Country:US
Practice Address - Phone:480-559-9744
Practice Address - Fax:480-559-9784
Is Sole Proprietor?:No
Enumeration Date:2012-11-02
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0750171100000X
WAAC60420884171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist