Provider Demographics
NPI:1730129107
Name:KOOPS, TERESA MARIE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:MARIE
Last Name:KOOPS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:MARIE
Other - Last Name:DUNN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:22135 LYNX CT
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-3038
Mailing Address - Country:US
Mailing Address - Phone:949-933-8897
Mailing Address - Fax:
Practice Address - Street 1:325 POTTER ST
Practice Address - Street 2:
Practice Address - City:FALLBROOK
Practice Address - State:CA
Practice Address - Zip Code:92028-3068
Practice Address - Country:US
Practice Address - Phone:760-728-2330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT26878225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT 26878 AMedicare ID - Type Unspecified