1992053201 NPI number — MRS. CAITLIN MARGARET COOPER P.T.

Table of content: MRS. CAITLIN MARGARET COOPER P.T. (NPI 1992053201)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992053201 NPI number — MRS. CAITLIN MARGARET COOPER P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COOPER
Provider First Name:
CAITLIN
Provider Middle Name:
MARGARET
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
P.T.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NEWKIRK
Provider Other First Name:
CAITLIN
Provider Other Middle Name:
MARGARET
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
P.T.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1992053201
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/16/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3908 VALLEY AVE
Provider Second Line Business Mailing Address:
STE. B
Provider Business Mailing Address City Name:
PLEASANTON
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94566-4872
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
925-417-8005
Provider Business Mailing Address Fax Number:
925-417-8881

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3908 VALLEY AVE
Provider Second Line Business Practice Location Address:
STE. B
Provider Business Practice Location Address City Name:
PLEASANTON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94566-4872
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
925-417-8005
Provider Business Practice Location Address Fax Number:
925-417-8881
Provider Enumeration Date:
08/16/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT36700 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: PT36700 . This is a "CA PT LICENSE #" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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