Provider Demographics
NPI:1306213640
Name:COOPER, KAYLEE RAE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KAYLEE
Middle Name:RAE
Last Name:COOPER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:KAYLEE
Other - Middle Name:RAE
Other - Last Name:SEUFERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:8823 PRODUCTION LN
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-6511
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:423-238-3473
Practice Address - Street 1:1453 RIVERSTONE PKWY
Practice Address - Street 2:STE 170
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-5626
Practice Address - Country:US
Practice Address - Phone:770-704-0774
Practice Address - Fax:770-704-0779
Is Sole Proprietor?:No
Enumeration Date:2015-08-21
Last Update Date:2017-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT012103225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist