Provider Demographics
NPI:1083844898
Name:COOPER, SHAWNA LYNN (MPT)
Entity Type:Individual
Prefix:MRS
First Name:SHAWNA
Middle Name:LYNN
Last Name:COOPER
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 S WILLOW ST STE 1
Mailing Address - Street 2:
Mailing Address - City:KENAI
Mailing Address - State:AK
Mailing Address - Zip Code:99611-9107
Mailing Address - Country:US
Mailing Address - Phone:907-714-4536
Mailing Address - Fax:907-283-7300
Practice Address - Street 1:130 S WILLOW ST STE 1
Practice Address - Street 2:
Practice Address - City:KENAI
Practice Address - State:AK
Practice Address - Zip Code:99611-9107
Practice Address - Country:US
Practice Address - Phone:907-714-4536
Practice Address - Fax:907-283-7300
Is Sole Proprietor?:No
Enumeration Date:2009-07-15
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1448225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist