Provider Demographics
NPI:1629341698
Name:COOPER, KYLE LEE (PT)
Entity Type:Individual
Prefix:MR
First Name:KYLE
Middle Name:LEE
Last Name:COOPER
Suffix:
Gender:M
Credentials:PT
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Mailing Address - Street 1:101 MANNING DR
Mailing Address - Street 2:DEPARTMENT OF PT/OT
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-4220
Mailing Address - Country:US
Mailing Address - Phone:984-974-2560
Mailing Address - Fax:919-843-2195
Practice Address - Street 1:100 SPRUNT ST
Practice Address - Street 2:ROOM 127
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27517-7811
Practice Address - Country:US
Practice Address - Phone:984-974-2560
Practice Address - Fax:919-843-2195
Is Sole Proprietor?:No
Enumeration Date:2012-02-21
Last Update Date:2015-10-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC133702251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCQ40934E107OtherMEDICARE PTAN