Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 2306602029 | VA |
NPI | 1245493345 |
---|---|
Provider Name | Christine Cooper |
First Address | Scottsville, VA 24590-4591 |
Second Address | Fork Union, VA 23055 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2008 |
Last Update Date | 08/07/2008 |