Provider Demographics
NPI:1083739080
Name:COOLEY, JOSEPH P (PT)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:P
Last Name:COOLEY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1707 WEST 20TH STREET
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MS
Mailing Address - Zip Code:39442
Mailing Address - Country:US
Mailing Address - Phone:601-428-2004
Mailing Address - Fax:601-428-8833
Practice Address - Street 1:1707 WEST 20TH STREET
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MS
Practice Address - Zip Code:39442
Practice Address - Country:US
Practice Address - Phone:601-428-2004
Practice Address - Fax:601-428-8833
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT0780225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS6430008OtherUNITED HEALTHCARE
MS256527Medicare ID - Type Unspecified