Provider Demographics
NPI:1568937241
Name:COOPER, CARLY ELISE (DPT)
Entity Type:Individual
Prefix:
First Name:CARLY
Middle Name:ELISE
Last Name:COOPER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8305 FALLS OF NEUSE RD STE 102
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-3546
Mailing Address - Country:US
Mailing Address - Phone:919-870-4444
Mailing Address - Fax:919-870-4447
Practice Address - Street 1:8305 FALLS OF NEUSE RD STE 102
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-3546
Practice Address - Country:US
Practice Address - Phone:919-870-4444
Practice Address - Fax:919-870-4447
Is Sole Proprietor?:No
Enumeration Date:2018-10-09
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP18000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist