Individual
MR. THEAVIS COOPER JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
1028 JC REDD DR WESSON, MISSISSIPPI 39191, WESSON, MS 39191
(601) 643-8479
Mailing address
507 HIGHWAY 51 N, PO BOX 948, BROOKHAVEN, MS 39601
(601) 754-8008
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
10/21/2016
Last updated
02/26/2019
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