Provider Demographics
NPI:1457979551
Name:COOPER REHABILITATION AND WELLNESS, LLC
Entity Type:Organization
Organization Name:COOPER REHABILITATION AND WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHAWNA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:907-252-2516
Mailing Address - Street 1:115 WOODED GLEN CT
Mailing Address - Street 2:
Mailing Address - City:KENAI
Mailing Address - State:AK
Mailing Address - Zip Code:99611-6867
Mailing Address - Country:US
Mailing Address - Phone:907-252-2516
Mailing Address - Fax:
Practice Address - Street 1:115 WOODED GLEN CT
Practice Address - Street 2:
Practice Address - City:KENAI
Practice Address - State:AK
Practice Address - Zip Code:99611-6867
Practice Address - Country:US
Practice Address - Phone:907-252-2516
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-06
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy