Provider Demographics
NPI:1205371747
Name:COOLEY, NATALIE (PT)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:
Last Name:COOLEY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 LOW CT
Mailing Address - Street 2:
Mailing Address - City:FAIRFIIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94534
Mailing Address - Country:US
Mailing Address - Phone:707-427-4900
Mailing Address - Fax:707-432-2661
Practice Address - Street 1:10470 OLD PLACERVILLE ROAD
Practice Address - Street 2:STE 100
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95827-2539
Practice Address - Country:US
Practice Address - Phone:800-470-0071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-19
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT292492225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist