Provider Demographics
NPI:1437193059
Name:SHELLEY A COOPER PT
Entity Type:Organization
Organization Name:SHELLEY A COOPER PT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:760-345-9934
Mailing Address - Street 1:78078 COUNTRY CLUB DR
Mailing Address - Street 2:SUITE 205
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92203
Mailing Address - Country:US
Mailing Address - Phone:760-345-9934
Mailing Address - Fax:760-345-3086
Practice Address - Street 1:78078 COUNTRY CLUB DR
Practice Address - Street 2:SUITE 205
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92203
Practice Address - Country:US
Practice Address - Phone:760-345-9934
Practice Address - Fax:760-345-3086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ22007ZMedicare ID - Type UnspecifiedPROVIDER NUMBER
CADD8992Medicare ID - Type UnspecifiedRAILROAD MEDICARE