Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 5501013002 | MI |
N | 2251N0400X | Physical Therapist - Neurology | 5501013002 | MI |
NPI | 1447676606 |
---|---|
Provider Name | Elizabeth Cooper |
First Address | Kalamazoo, MI 49006-1358 |
Second Address | Kalamazoo, MI 49006-1358 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/03/2014 |
Last Update Date | 12/03/2014 |