MEDICARE: JOHN KOPSKY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2251G0304X	Geriatric Physical Therapist	2021021473	MO

General Provider Information

NPI Number	:	1184313769
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN KOPSKY

Provider Business Mailing Address
First Line	:	3619 TAMM AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63109-1358
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1333 SCENIC DR
Second Line	:
City	:	HERCULANEUM
State	:	MO
Zip	:	63048-1550
Country	:	US
Telephone Number	:	636-931-2995
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/01/2023
Last Update Date	:	05/01/2023

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Directions to “ JOHN KOPSKY ” Practice Location

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