Organization
COOPER CLINIC PA
Active
Organization
COOPER CLINIC PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. GAYLA DENISE PAUL (CREDENTIALING & CONTRACT MANAGER)
(479) 274-2004
Entity
Organization
Contact information
Practice address
6801 ROGERS AVE, FORT SMITH, AR 72903-4067
(479) 274-2110
Mailing address
PO BOX 3528, FORT SMITH, AR 72913-3528
(479) 274-2004
(479) 274-2024
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
MC-0254
AR
Other
Enumeration date
07/26/2016
Last updated
07/26/2016
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