Provider Demographics
NPI:1073581054
Name:COOPER, TRAVIS R (LPTA)
Entity Type:Individual
Prefix:MR
First Name:TRAVIS
Middle Name:R
Last Name:COOPER
Suffix:
Gender:M
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2125 EXECUTIVE PARK DR
Mailing Address - Street 2:
Mailing Address - City:OPELIKA
Mailing Address - State:AL
Mailing Address - Zip Code:36801-6041
Mailing Address - Country:US
Mailing Address - Phone:334-741-4041
Mailing Address - Fax:334-741-0065
Practice Address - Street 1:2125 EXECUTIVE PARK DR
Practice Address - Street 2:
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36801-6041
Practice Address - Country:US
Practice Address - Phone:334-741-4041
Practice Address - Fax:334-741-0065
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-08
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTA1442225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant