Individual
KENNEDY LAKE COOPER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
31 SCHOOL DR, MELBOURNE, AR 72556-8620
(870) 916-2269
(870) 277-0896
Mailing address
31 SCHOOL DR, MELBOURNE, AR 72556-8620
(870) 916-2269
(870) 277-0896
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
4841
AR
Other
Enumeration date
07/13/2023
Last updated
07/13/2023
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