Provider Demographics
NPI:1235394065
Name:COOPER, ADRIENNE L (PTA)
Entity Type:Individual
Prefix:MRS
First Name:ADRIENNE
Middle Name:L
Last Name:COOPER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2612 BOBWHITE CIR
Mailing Address - Street 2:
Mailing Address - City:WINGATE
Mailing Address - State:NC
Mailing Address - Zip Code:28174-9673
Mailing Address - Country:US
Mailing Address - Phone:704-233-1847
Mailing Address - Fax:
Practice Address - Street 1:2612 BOBWHITE CIR
Practice Address - Street 2:
Practice Address - City:WINGATE
Practice Address - State:NC
Practice Address - Zip Code:28174-9673
Practice Address - Country:US
Practice Address - Phone:704-233-1847
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-21
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1402225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant