Individual
MRS. JENELLE L COOPER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MPT
Contact information
Practice address
40900 MERCHANTS LN, LEONARDTOWN, MD 20650-3795
(301) 997-1155
Mailing address
PO BOX 2327, LEONARDTOWN, MD 20650-8327
(301) 997-1155
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
20634
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
411592
MAMSI
—
01
—
58880008
BS DC
—
01
—
61644501
BSMD
—
Enumeration date
12/02/2005
Last updated
09/15/2015
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