Individual
DALE COOPER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
28 PEACHTREE LN, MADISON, MS 39110-7452
(800) 330-7711
Mailing address
28 PEACHTREE LN, MADISON, MS 39110-7452
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA5588
NC
Other
Enumeration date
08/19/2014
Last updated
08/19/2014
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