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Organization
KIPP M COOPER PT PLLC
Active
Organization
KIPP M COOPER PT PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIPP MARTIN COOPER PT (OWNER)
(607) 334-5074
Entity
Organization
Contact information
Practice address
26 CONKEY AVE, NORWICH, NY 13815-1756
(607) 334-5074
Mailing address
26 CONKEY AVE, P O BOX 148, NORWICH, NY 13815-1756
(607) 334-5074
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00007823
EXCELLUSBLUECROSSBLUESHIE
NY
Enumeration date
05/04/2007
Last updated
05/13/2008
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