Provider Demographics
NPI:1740653567
Name:COOPER, ANDREA (PTA)
Entity type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:
Last Name:COOPER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1445 N LIMESTONE ST
Mailing Address - Street 2:
Mailing Address - City:GAFFNEY
Mailing Address - State:SC
Mailing Address - Zip Code:29340-4735
Mailing Address - Country:US
Mailing Address - Phone:864-487-7874
Mailing Address - Fax:864-487-7659
Practice Address - Street 1:1445 N LIMESTONE ST
Practice Address - Street 2:
Practice Address - City:GAFFNEY
Practice Address - State:SC
Practice Address - Zip Code:29340-4735
Practice Address - Country:US
Practice Address - Phone:864-487-7874
Practice Address - Fax:864-487-7659
Is Sole Proprietor?:No
Enumeration Date:2015-11-02
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC32272251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic