Provider Demographics
NPI:1235112046
Name:COOPER, LAURA CHRISTINE (MSPT CSCS)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:CHRISTINE
Last Name:COOPER
Suffix:
Gender:F
Credentials:MSPT CSCS
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Mailing Address - Street 1:16083 SW UPPER BOONES FERRY RD
Mailing Address - Street 2:STE 300
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-7736
Mailing Address - Country:US
Mailing Address - Phone:800-219-8835
Mailing Address - Fax:503-639-9699
Practice Address - Street 1:61615 ATHLETIC CLUB DR
Practice Address - Street 2:TAI CENTRAL OREGON ATHLETIC CLUB
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-3124
Practice Address - Country:US
Practice Address - Phone:541-382-7890
Practice Address - Fax:541-382-7498
Is Sole Proprietor?:No
Enumeration Date:2005-11-25
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OR3741225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR295473Medicaid
ORP01617907OtherRR MEDICARE
ORP01617907OtherRR MEDICARE
OR295473Medicaid