Mac Cooper, PTA

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

License

PTA5126 Issued in ID

Practice address

802 Shoup St
Salmon, ID 83467-4305

Phone

(208) 756-2005

Fax

(208) 756-4020

NPI assigned

May 23, 2017

Last updated

May 23, 2017By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Specialty

Undefined Non-Physician Type (Specify)

Education

Other, 2017

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1495497600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1495497600000",
    "number": "1831627710",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1107",
            "city": "SALMON",
            "state": "ID",
            "postal_code": "834671107",
            "telephone_number": "208-756-2005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "802 SHOUP ST",
            "city": "SALMON",
            "state": "ID",
            "postal_code": "834674305",
            "telephone_number": "208-756-2005",
            "fax_number": "208-756-4020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COOPER",
        "first_name": "MAC",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-05-23",
        "last_updated": "2017-05-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "ID",
            "license": "PTA5126",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brittany Marie Cole, PHARM.D.
• Danielle Christina Connella, LCSW
• Iris Marie Conrad
• Elaine Constantinescu, RMA, PBT(ASCP)
• Katherine I Contway, MSW LCSW
• Countryside Home Care, Inc
• County of Lemhi (Lemhi County Ambulance)
• Dahle Physical Therapy, PLLC
• Annah Benedict Dahle, DPT
• Jessika An Daley

• Physical Medicine & Rehabilitation Physician in Salmon, ID
• Providers in Salmon, ID by specialty
• Physical Medicine & Rehabilitation Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.