Provider Demographics
NPI:1245236272
Name:COOPER, JAMES RAY (PT)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:RAY
Last Name:COOPER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:MR
Other - First Name:J.R.
Other - Middle Name:
Other - Last Name:COOPER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:235 N GILBERT ST
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543-4013
Mailing Address - Country:US
Mailing Address - Phone:951-658-9000
Mailing Address - Fax:
Practice Address - Street 1:235 N GILBERT ST
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-4013
Practice Address - Country:US
Practice Address - Phone:951-658-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT15660225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PT156601Medicare PIN