Healthcare Provider Details

I. General information

NPI: 1013597590
Provider Name (Legal Business Name): JULIUS LEE COPELAND JR. MASSAGE THERAPIST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2021
Last Update Date: 04/09/2021
Certification Date: 04/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3097 WILLOW AVE STE 20
CLOVIS CA
93612-4715
US

IV. Provider business mailing address

3097 WILLOW AVE STE 20
CLOVIS CA
93612-4715
US

V. Phone/Fax

Practice location:
  • Phone: 559-477-0634
  • Fax:
Mailing address:
  • Phone: 559-477-0634
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number84328
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: