Provider Demographics
NPI:1356337513
Name:COOPER, JOSHUA PAUL (ATC)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:PAUL
Last Name:COOPER
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2128 PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54603-2067
Mailing Address - Country:US
Mailing Address - Phone:608-779-5625
Mailing Address - Fax:
Practice Address - Street 1:3100 S KINNEY COULEE RD
Practice Address - Street 2:GUNDERSEN LUTHERAN SPORTS MEDICINE
Practice Address - City:ONALASKA
Practice Address - State:WI
Practice Address - Zip Code:54650-8512
Practice Address - Country:US
Practice Address - Phone:608-775-8600
Practice Address - Fax:608-775-8614
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI498-0392255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer