Provider Demographics
NPI:1447206750
Name:COOPER-JOHNSON, KRISTI L (RPT)
Entity Type:Individual
Prefix:MRS
First Name:KRISTI
Middle Name:L
Last Name:COOPER-JOHNSON
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1418 RIMROCK DR
Mailing Address - Street 2:
Mailing Address - City:GUYMON
Mailing Address - State:OK
Mailing Address - Zip Code:73942-3164
Mailing Address - Country:US
Mailing Address - Phone:580-468-4307
Mailing Address - Fax:
Practice Address - Street 1:421 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:GUYMON
Practice Address - State:OK
Practice Address - Zip Code:73942-3640
Practice Address - Country:US
Practice Address - Phone:580-338-4676
Practice Address - Fax:580-338-4686
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2329225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist