Provider Demographics
NPI:1447204037
Name:COOPER, CARRIE A (PT, MSPT)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:A
Last Name:COOPER
Suffix:
Gender:F
Credentials:PT, MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9634 SUN MEADOW ST
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80129-6271
Mailing Address - Country:US
Mailing Address - Phone:303-471-6212
Mailing Address - Fax:
Practice Address - Street 1:6851 S HOLLY CIR STE 100
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112
Practice Address - Country:US
Practice Address - Phone:303-771-3745
Practice Address - Fax:303-771-3728
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7064225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO7064OtherPHYSICAL THERAPIST
COC477678Medicare PIN