Provider Demographics
NPI:1932724838
Name:COOPER, SHAKYRA JANAI (PT, DPT)
Entity Type:Individual
Prefix:
First Name:SHAKYRA
Middle Name:JANAI
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 1:95-1057 AINAMAKUA DR STE F-11
Mailing Address - Street 2:
Mailing Address - City:MILILANI
Mailing Address - State:HI
Mailing Address - Zip Code:96789-6310
Mailing Address - Country:US
Mailing Address - Phone:808-597-1005
Mailing Address - Fax:808-657-3222
Practice Address - Street 1:95-1057 AINAMAKUA DR STE F-11
Practice Address - Street 2:
Practice Address - City:MILILANI
Practice Address - State:HI
Practice Address - Zip Code:96789-6310
Practice Address - Country:US
Practice Address - Phone:808-597-1005
Practice Address - Fax:808-657-3222
Is Sole Proprietor?:No
Enumeration Date:2020-06-16
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10605225100000X
HIPT-5338225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist