Provider Demographics
NPI:1881392553
Name:COOPER, GILLIAN CORRYN (PT, DPT)
Entity type:Individual
Prefix:MRS
First Name:GILLIAN
Middle Name:CORRYN
Last Name:COOPER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:257 INTEGRA AVE SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97306-2172
Mailing Address - Country:US
Mailing Address - Phone:503-871-5542
Mailing Address - Fax:
Practice Address - Street 1:3270 LIBERTY RD S
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-4560
Practice Address - Country:US
Practice Address - Phone:503-749-9743
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-21
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR64856225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist