Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | PT023869 | PA |
Y | 2251P0200X | Physical Therapist - Pediatrics | 22120 | MA |
NPI | 1033569561 |
---|---|
Provider Name | Sarah Cooper |
First Address | Sherman, CT 06784-0447 |
Second Address | Boston, MA 02115-5724 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2016 |
Last Update Date | 15/06/2016 |