MEDICARE: DR. CRYSTAL L COPELAND DPT

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	225100000X	Physical Therapist	P13363	NC

General Provider Information

NPI Number	:	1851667745
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CRYSTAL L COPELAND DPT

Provider Business Mailing Address
First Line	:	125 LEE CIR
Second Line	:
City	:	ELIZABETH CITY
State	:	NC
Zip	:	27909-7946
Country	:	US
Telephone Number	:	252-312-9098
Fax Number	:

Provider Business Practice Location Address
First Line	:	125 LEE CIR
Second Line	:
City	:	ELIZABETH CITY
State	:	NC
Zip	:	27909-7946
Country	:	US
Telephone Number	:	252-312-9098
Fax Number	:

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

Provider Enumeration Date	:	03/26/2012
Last Update Date	:	03/26/2012

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