Provider Demographics
NPI:1477677821
Name:JOEL N COOPER PHYSICAL THERAPIST INC.
Entity Type:Organization
Organization Name:JOEL N COOPER PHYSICAL THERAPIST INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:N
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-746-3844
Mailing Address - Street 1:142 E TULARE AVE
Mailing Address - Street 2:
Mailing Address - City:SHAFTER
Mailing Address - State:CA
Mailing Address - Zip Code:93263-1834
Mailing Address - Country:US
Mailing Address - Phone:661-746-3844
Mailing Address - Fax:661-746-1243
Practice Address - Street 1:142 E TULARE AVE
Practice Address - Street 2:
Practice Address - City:SHAFTER
Practice Address - State:CA
Practice Address - Zip Code:93263-1834
Practice Address - Country:US
Practice Address - Phone:661-746-3844
Practice Address - Fax:661-746-1243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT8213225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00PT82131Medicare ID - Type Unspecified