Provider Demographics
NPI:1013175090
Name:COOPER, JENIFER MAY (MPT)
Entity Type:Individual
Prefix:MRS
First Name:JENIFER
Middle Name:MAY
Last Name:COOPER
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:MINOTOLA
Mailing Address - State:NJ
Mailing Address - Zip Code:08341-1005
Mailing Address - Country:US
Mailing Address - Phone:856-697-1688
Mailing Address - Fax:
Practice Address - Street 1:640 WHITE HORSE PIKE
Practice Address - Street 2:
Practice Address - City:HAMMONTON
Practice Address - State:NJ
Practice Address - Zip Code:08037-9602
Practice Address - Country:US
Practice Address - Phone:609-704-1980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-27
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01261900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist