Individual
KELLY L COOPER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
4660 KENMORE AVE, SUITE 420, ALEXANDRIA, VA 22304-1313
(703) 751-1008
(703) 751-1118
Mailing address
5252 LYNGATE CT, STE 203, BURKE, VA 22015-1672
(703) 239-2300
(703) 239-2301
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2305207085
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2307000967
DIRECT ACCESS CERTIFICATION
VA
01
—
K949 - 0031
CAREFIRST
VA
Enumeration date
05/04/2012
Last updated
09/17/2015
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