Mac Cooper, PTA
Mac Cooper, PTA is an Undefined Non-Physician Type (Specify) in Salmon, Idaho. Qualified in 2017, 9 years ago. Licensed in Idaho.
- Years since qualifying
- 9
- Licensed in
- ID
- In the registry since
- 2017
What do these letters mean?
- PTA — Physical Therapist Assistant
- Delivers treatment under a physical therapist's direction.
Practice location Address checks out
802 Shoup StSalmon, ID 83467-4305
Phone: (208) 756-2005
Fax: (208) 756-4020
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Pin is approximate — placed at the ZIP-code centre, not the exact door.
Specialties & licences
| Physical Medicine & Rehabilitation Physician (primary) | Taxonomy 208100000X · Licence PTA5126 (ID) |
|---|
Record details
| NPI number | 1831627710 |
|---|---|
| Entity type | Individual (Type 1) |
| Gender | Male |
| Credentials | PTA |
| Sole proprietor | No |
| NPI enumerated | May 23, 2017 |
| Last updated in NPPES | May 23, 2017 |
| Mailing address | Po Box 1107, Salmon, ID 83467-1107 |
Medicare enrollment
| Medicare specialty | UNDEFINED NON-PHYSICIAN TYPE (SPECIFY) |
|---|---|
| Medical school | OTHER |
| Graduated | 2017 (9 years in practice) |
| Accepts Medicare assignment | Not indicated |
| Practice locations | 2 on file with Medicare |