Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 26763 | MD |
NPI | 1013420884 |
---|---|
Provider Name | Laura Leigh Cooper |
First Address | Fruitland, MD 21826-1101 |
Second Address | Bethesda, MD 20814-1745 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2017 |
Last Update Date | 14/11/2017 |