Provider Demographics
NPI:1902022684
Name:COOPER, CHARMAINE LOUISE (PT)
Entity Type:Individual
Prefix:MS
First Name:CHARMAINE
Middle Name:LOUISE
Last Name:COOPER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3883 TURTLE CREEK BLVD
Mailing Address - Street 2:#1909
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-4402
Mailing Address - Country:US
Mailing Address - Phone:214-526-1885
Mailing Address - Fax:
Practice Address - Street 1:3883 TURTLE CREEK BLVD
Practice Address - Street 2:#1909
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219-4402
Practice Address - Country:US
Practice Address - Phone:214-526-1885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1039253225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist