Provider Demographics
NPI:1679667976
Name:COOPER, TARA (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:COOPER
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3460 KATELLA AVENUE
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720
Mailing Address - Country:US
Mailing Address - Phone:562-594-6599
Mailing Address - Fax:562-598-6220
Practice Address - Street 1:3460 KATELLA AVENUE
Practice Address - Street 2:
Practice Address - City:LOS KATELLA AVENUE
Practice Address - State:CA
Practice Address - Zip Code:90720
Practice Address - Country:US
Practice Address - Phone:562-594-6599
Practice Address - Fax:562-598-6220
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT11651225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist