Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | PTA 20522 | FL |
NPI | 1013271402 |
---|---|
Provider Name | Crystal Cooper |
First Address | Tallahassee, FL 32304-3763 |
Second Address | Tallahassee, FL 32308-4437 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2012 |
Last Update Date | 29/06/2012 |