Provider Demographics
NPI:1487005419
Name:COOPER, SUSIE KATRIN (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:SUSIE
Middle Name:KATRIN
Last Name:COOPER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22737 MOUNT EDEN RD
Mailing Address - Street 2:
Mailing Address - City:SARATOGA
Mailing Address - State:CA
Mailing Address - Zip Code:95070-9711
Mailing Address - Country:US
Mailing Address - Phone:408-429-4009
Mailing Address - Fax:
Practice Address - Street 1:22737 MOUNT EDEN RD
Practice Address - Street 2:
Practice Address - City:SARATOGA
Practice Address - State:CA
Practice Address - Zip Code:95070-9711
Practice Address - Country:US
Practice Address - Phone:408-429-4009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-30
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305210267225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist