Provider Demographics
NPI:1205898863
Name:COOPER, AMY L (DPT)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:L
Last Name:COOPER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:L
Other - Last Name:MASSINGILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:255 ELK RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-8972
Mailing Address - Country:US
Mailing Address - Phone:970-946-9380
Mailing Address - Fax:
Practice Address - Street 1:3180 NORTH BUTLER AVE.
Practice Address - Street 2:BLDG. 300
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401
Practice Address - Country:US
Practice Address - Phone:505-326-2460
Practice Address - Fax:505-325-1943
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8249225100000X
NM2930225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO543198Medicare ID - Type Unspecified