Provider Demographics
NPI:1629341698
Name:COOPER, KYLE LEE (PT)
Entity type:Individual
Prefix:MR
First Name:KYLE
Middle Name:LEE
Last Name:COOPER
Suffix:
Gender:M
Credentials:PT
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Mailing Address - Street 1:101 MANNING DR
Mailing Address - Street 2:DEPARTMENT OF PT/OT
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-4220
Mailing Address - Country:US
Mailing Address - Phone:984-974-2560
Mailing Address - Fax:919-843-2195
Practice Address - Street 1:100 SPRUNT ST
Practice Address - Street 2:ROOM 127
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27517-7811
Practice Address - Country:US
Practice Address - Phone:984-974-2560
Practice Address - Fax:919-843-2195
Is Sole Proprietor?:No
Enumeration Date:2012-02-21
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC133702251X0800X
NCP13370225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCQ40934E107OtherMEDICARE PTAN