Provider Demographics
NPI:1053567636
Name:COOPER, CATHY G (PT)
Entity type:Individual
Prefix:
First Name:CATHY
Middle Name:G
Last Name:COOPER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:813 W THIRD ST
Mailing Address - Street 2:
Mailing Address - City:FOREST
Mailing Address - State:MS
Mailing Address - Zip Code:39074-4006
Mailing Address - Country:US
Mailing Address - Phone:601-469-1001
Mailing Address - Fax:601-469-1009
Practice Address - Street 1:813 WEST 3RD STREET
Practice Address - Street 2:
Practice Address - City:FOREST
Practice Address - State:MS
Practice Address - Zip Code:39074
Practice Address - Country:US
Practice Address - Phone:601-469-1001
Practice Address - Fax:601-469-1009
Is Sole Proprietor?:No
Enumeration Date:2008-08-14
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT4352225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist