Provider Demographics
NPI:1417147232
Name:COOPER, LISA BETH (PTA)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:BETH
Last Name:COOPER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 CAPTAIN SAMADRUS RD
Mailing Address - Street 2:
Mailing Address - City:COTUIT
Mailing Address - State:MA
Mailing Address - Zip Code:02635-2709
Mailing Address - Country:US
Mailing Address - Phone:508-428-9414
Mailing Address - Fax:508-428-9414
Practice Address - Street 1:721 E FALMOUTH HWY
Practice Address - Street 2:
Practice Address - City:EAST FALMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02536-6191
Practice Address - Country:US
Practice Address - Phone:508-540-7609
Practice Address - Fax:508-540-7539
Is Sole Proprietor?:No
Enumeration Date:2007-07-27
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7937225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant