Provider Demographics
NPI:1295181030
Name:KOOPS, BRITTANY ANA (MAT, ATC, LAT)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:ANA
Last Name:KOOPS
Suffix:
Gender:F
Credentials:MAT, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6800 WYDOWN BLVD
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:MO
Mailing Address - Zip Code:63105-3043
Mailing Address - Country:US
Mailing Address - Phone:314-889-1456
Mailing Address - Fax:
Practice Address - Street 1:6800 WYDOWN BLVD
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:MO
Practice Address - Zip Code:63105-3043
Practice Address - Country:US
Practice Address - Phone:314-889-1456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-11
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20150262732255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer