Provider Demographics
NPI:1821452228
Name:COOPER, DAVID TYLER (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:TYLER
Last Name:COOPER
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 MONTCLAIR RD STE 202
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35213-1964
Mailing Address - Country:US
Mailing Address - Phone:205-747-2710
Mailing Address - Fax:
Practice Address - Street 1:101 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:COLUMBIANA
Practice Address - State:AL
Practice Address - Zip Code:35051-9325
Practice Address - Country:US
Practice Address - Phone:256-738-6808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-12
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL17372255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer