Provider Demographics
NPI:1639189210
Name:COOPER, ALICE HARRIOTT (PT)
Entity type:Individual
Prefix:MS
First Name:ALICE
Middle Name:HARRIOTT
Last Name:COOPER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:ALICE
Other - Middle Name:HARRIOTT
Other - Last Name:HUTCHERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:690 ROSE LN
Mailing Address - Street 2:PO BOX 679
Mailing Address - City:SALADO
Mailing Address - State:TX
Mailing Address - Zip Code:76571-0679
Mailing Address - Country:US
Mailing Address - Phone:254-947-5701
Mailing Address - Fax:254-947-5701
Practice Address - Street 1:690 ROSE LN
Practice Address - Street 2:
Practice Address - City:SALADO
Practice Address - State:TX
Practice Address - Zip Code:76571-0679
Practice Address - Country:US
Practice Address - Phone:254-947-5701
Practice Address - Fax:254-947-5701
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1039873225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist