Provider Demographics
NPI:1811996226
Name:COOPER, ELAINE J (DPT)
Entity type:Individual
Prefix:DR
First Name:ELAINE
Middle Name:J
Last Name:COOPER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29805 MIDDLEBELT RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-2317
Mailing Address - Country:US
Mailing Address - Phone:248-850-7050
Mailing Address - Fax:248-850-8597
Practice Address - Street 1:29805 MIDDLEBELT RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-2317
Practice Address - Country:US
Practice Address - Phone:248-850-7050
Practice Address - Fax:248-850-8597
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2015-06-08
Deactivation Date:2006-03-18
Deactivation Code:
Reactivation Date:2006-03-23
Provider Licenses
StateLicense IDTaxonomies
MI5501000015225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist