Provider Demographics
NPI:1689034282
Name:COOPER, RACHEL JENNIFER (LMT)
Entity Type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:JENNIFER
Last Name:COOPER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MISS
Other - First Name:RACHEL
Other - Middle Name:JENNIFER
Other - Last Name:MORENO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:120 LAUREL LEAH
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48430-8784
Mailing Address - Country:US
Mailing Address - Phone:810-964-7007
Mailing Address - Fax:
Practice Address - Street 1:120 LAUREL LEAH
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MI
Practice Address - Zip Code:48430-8784
Practice Address - Country:US
Practice Address - Phone:810-964-7007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-25
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501003137172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist