Provider Demographics
NPI:1275575763
Name:COOPER, JACQUELINE (RPT)
Entity Type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:
Last Name:COOPER
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:
Other - Last Name:SEIBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:1750 FOUNDERS PKWY
Mailing Address - Street 2:130
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30009-7602
Mailing Address - Country:US
Mailing Address - Phone:678-624-9117
Mailing Address - Fax:678-624-0747
Practice Address - Street 1:1750 FOUNDERS PKWY
Practice Address - Street 2:130
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30009-7602
Practice Address - Country:US
Practice Address - Phone:678-624-9117
Practice Address - Fax:678-624-0747
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT008297225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA65BBDCFMedicare ID - Type Unspecified