Provider Demographics
NPI:1396524070
Name:COOPER REHABILITATION CONSULTING PLLC
Entity type:Organization
Organization Name:COOPER REHABILITATION CONSULTING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:L
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO
Authorized Official - Phone:252-847-4268
Mailing Address - Street 1:5829 CAMPBELLTON RD SW STE 104-200
Mailing Address - Street 2:
Mailing Address - City:SOUTH FULTON
Mailing Address - State:GA
Mailing Address - Zip Code:30331-8037
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2200 PATRICK HENRY PKWY
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-4207
Practice Address - Country:US
Practice Address - Phone:678-620-8035
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-22
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty