Active NPI
Justin Cooper, PT
- Physical Therapist
- Broken Arrow, OK
National Provider Identifier
1417260654
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 4311
- Practice address
- 505 S Aspen Ave
Broken Arrow, OK 74012-2296 - Phone
- (918) 994-5333
- Fax
- (918) 994-5334
- NPI assigned
- Jul 16, 2010
- Last updated
- Dec 12, 2011
- Sex
- Male
- 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 | 4311 | OK | Primary |
Addresses
Primary practice location
505 S Aspen Ave
Broken Arrow, OK 74012-2296
Mailing address
6585 S Yale Ave
Ste 200
Tulsa, OK 74136-8384
Phone (918) 481-2767
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)
- Not enrolled
- HHS exclusion list flag
- CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found.
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| TEMP | OK | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Advanced Orthopedics of Oklahoma PLLC | Physical Therapist | Past | Accepting new patients |
| Freedom Hearing | Past | Accepting new patients |
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/HGJHAD
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Advanced Orthopedics of Oklahoma
- Orthopaedic Surgery Physician
- Owasso, OK
- NPI 1104663996
Physical Therapist
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1279238400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1323648000000",
"number": "1417260654",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6585 S YALE AVE",
"address_2": "STE 200",
"city": "TULSA",
"state": "OK",
"postal_code": "741368384",
"telephone_number": "918-481-2767",
"fax_number": "918-481-7611"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "505 S ASPEN AVE",
"city": "BROKEN ARROW",
"state": "OK",
"postal_code": "740122296",
"telephone_number": "918-994-5333",
"fax_number": "918-994-5334"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COOPER",
"first_name": "JUSTIN",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-07-16",
"last_updated": "2011-12-12",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "OK",
"license": "4311",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Broken Arrow, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.