Provider Demographics
NPI:1730539214
Name:COOPER, CATHERINE GRANT (MD)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:GRANT
Last Name:COOPER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1595 VALLEY WIND LN
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59804-5867
Mailing Address - Country:US
Mailing Address - Phone:406-327-4308
Mailing Address - Fax:406-327-3820
Practice Address - Street 1:2835 FORT MISSOULA RD STE 204
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59804-7424
Practice Address - Country:US
Practice Address - Phone:406-327-4308
Practice Address - Fax:406-327-3820
Is Sole Proprietor?:No
Enumeration Date:2016-06-15
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTMED-PHYS-LIC-100643208100000X
COTL 0006337390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation