Provider Demographics
NPI:1750317517
Name:COOPER, JEFFREY W (RPT)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:W
Last Name:COOPER
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:588 BARRINGTON CT
Mailing Address - Street 2:
Mailing Address - City:NEWBURY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91320-5114
Mailing Address - Country:US
Mailing Address - Phone:805-498-2908
Mailing Address - Fax:
Practice Address - Street 1:2667 N MOORPARK RD
Practice Address - Street 2:#108
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-3001
Practice Address - Country:US
Practice Address - Phone:805-492-0429
Practice Address - Fax:805-492-0308
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT26969225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT26969OtherRPT LICENSE NUMBER