Healthcare Provider Details

I. General information

NPI: 1841250198
Provider Name (Legal Business Name): JEFFREY DOUGLAS COPPOCK MS PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 07/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 NW 4TH ST
BRYANT AR
72022-3424
US

IV. Provider business mailing address

9778 SPRINGHILL FARMS DR
ALEXANDER AR
72002-8998
US

V. Phone/Fax

Practice location:
  • Phone: 501-847-5660
  • Fax:
Mailing address:
  • Phone: 501-588-7674
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA936
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT2660
License Number StateAR
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT2370
License Number StateAR
# 4
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA2715
License Number StateAR
# 5
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOTR825
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: