Active NPI
Jennifer Lynn Cooper, P.T.
- Physical Therapist
- South Lake Tahoe, CA
National Provider Identifier
1407806821
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT 1642
- Practice address
- 812 Emerald Bay Rd
South Lake Tahoe, CA 96150-6413 - Phone
- (530) 542-2662
- Fax
- (530) 542-2661
- NPI assigned
- May 10, 2006
- Last updated
- Jan 25, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT 1642 | CA | Primary |
Addresses
Primary practice location
812 Emerald Bay Rd
South Lake Tahoe, CA 96150-6413
Mailing address
812 Emerald Bay Rd
S Lake Tahoe, CA 96150-6413
Phone (530) 542-2662
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT 1642 | CA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147219200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1201219200000",
"number": "1407806821",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "812 EMERALD BAY RD",
"city": "S LAKE TAHOE",
"state": "CA",
"postal_code": "961506413",
"telephone_number": "530-542-2662",
"fax_number": "530-542-2661"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "812 EMERALD BAY RD",
"city": "SOUTH LAKE TAHOE",
"state": "CA",
"postal_code": "961506413",
"telephone_number": "530-542-2662",
"fax_number": "530-542-2661"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COOPER",
"first_name": "JENNIFER",
"middle_name": "LYNN",
"credential": "P.T.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-05-10",
"last_updated": "2008-01-25",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "PT 1642",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in South Lake Tahoe, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.