Provider Demographics
NPI:1346674249
Name:COOPER, JASON ROSS (DPT)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:ROSS
Last Name:COOPER
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 9TH AVE
Mailing Address - Street 2:SUITE 810
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-4962
Mailing Address - Country:US
Mailing Address - Phone:212-624-1080
Mailing Address - Fax:
Practice Address - Street 1:76 9TH AVE
Practice Address - Street 2:SUITE 810
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-4962
Practice Address - Country:US
Practice Address - Phone:212-624-1080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-27
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40427225100000X
NY040273225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist