Provider Demographics
NPI:1659655363
Name:COOPER, SEDRIC (PT)
Entity Type:Individual
Prefix:
First Name:SEDRIC
Middle Name:
Last Name:COOPER
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 1:251 JOHNSTON ST SE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-2515
Mailing Address - Country:US
Mailing Address - Phone:256-340-9708
Mailing Address - Fax:256-340-9624
Practice Address - Street 1:1355 BESSEMER RD
Practice Address - Street 2:SUITE B
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35208-4325
Practice Address - Country:US
Practice Address - Phone:205-277-7379
Practice Address - Fax:205-518-8512
Is Sole Proprietor?:No
Enumeration Date:2011-09-30
Last Update Date:2016-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH6930225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1003819608OtherGROUP NPI
AL529917620Medicaid
AL1003819608OtherGROUP NPI