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Individual
MR. KYLE LEE COOPER
Active
Individual
MR. KYLE LEE COOPER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
P13370
NC
2251X0800X
Orthopedic Physical Therapist
Primary
13370
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
Q40934E107
MEDICARE PTAN
NC
Enumeration date
02/21/2012
Last updated
11/07/2024
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