Individual
MARY E COOPER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS PHYSICAL EDU
Contact information
Practice address
1000 EDDY STREET, PROVIDENCE, RI 02905
(401) 533-9100
Mailing address
1000 EDDY STREET, PROVIDENCE, RI 02905
(401) 533-9100
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2058
—
RI
01
—
6400144
SS UHP
RI
05
—
9009994
—
RI
05
—
99947
—
RI
Enumeration date
07/20/2006
Last updated
07/09/2007
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