Provider Demographics
NPI:1538128103
Name:COOPER, ROSS JUSTIN (MA, ATC, CSCS)
Entity Type:Individual
Prefix:
First Name:ROSS
Middle Name:JUSTIN
Last Name:COOPER
Suffix:
Gender:M
Credentials:MA, ATC, CSCS
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:3818 DUKESHIRE HWY
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-6430
Mailing Address - Country:US
Mailing Address - Phone:248-549-3135
Mailing Address - Fax:
Practice Address - Street 1:22305 W 13 MILE RD
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:MI
Practice Address - Zip Code:48025-4435
Practice Address - Country:US
Practice Address - Phone:248-646-7717
Practice Address - Fax:248-540-2152
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer