Provider Demographics
NPI:1619910304
Name:COOPER, KATHLEEN A (RPT)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:A
Last Name:COOPER
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:MISS
Other - First Name:KATHLEEN
Other - Middle Name:A
Other - Last Name:FORBES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPT
Mailing Address - Street 1:607 S MAIN ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:CONCORDIA
Mailing Address - State:MO
Mailing Address - Zip Code:64020-2503
Mailing Address - Country:US
Mailing Address - Phone:660-463-7494
Mailing Address - Fax:
Practice Address - Street 1:PHYSICAL THERAPY OF CONCORDIA
Practice Address - Street 2:607 SOUTH MAIN STREET, SUITE A
Practice Address - City:CONCORDIA
Practice Address - State:MO
Practice Address - Zip Code:64020
Practice Address - Country:US
Practice Address - Phone:660-463-2588
Practice Address - Fax:660-463-2589
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO111564225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO34224016OtherBCBSKC
MO34224016OtherBCBSKC