Provider Demographics
NPI:1639889702
Name:COLLINGS, COOPER (PT)
Entity Type:Individual
Prefix:
First Name:COOPER
Middle Name:
Last Name:COLLINGS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17100 N 67TH AVE BLDG 100
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-3612
Mailing Address - Country:US
Mailing Address - Phone:623-979-2747
Mailing Address - Fax:
Practice Address - Street 1:17100 N 67TH AVE BLDG 100
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-3612
Practice Address - Country:US
Practice Address - Phone:623-979-2747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-30
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPT-32618208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation