Provider Demographics
NPI:1639565385
Name:COOPER, SAMANTHA DAWN (ATC)
Entity Type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:DAWN
Last Name:COOPER
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:DAWN
Other - Last Name:WHITSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:1650 AUBURN SCHOOL DR
Mailing Address - Street 2:
Mailing Address - City:RINER
Mailing Address - State:VA
Mailing Address - Zip Code:24149-1103
Mailing Address - Country:US
Mailing Address - Phone:540-292-2090
Mailing Address - Fax:
Practice Address - Street 1:1650 AUBURN SCHOOL DR
Practice Address - Street 2:
Practice Address - City:RINER
Practice Address - State:VA
Practice Address - Zip Code:24149-1103
Practice Address - Country:US
Practice Address - Phone:540-292-2090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-09
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260021682255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer