Healthcare Provider Details

I. General information

NPI: 1144201856
Provider Name (Legal Business Name): ANTOINETTE MARIE COPE PT
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 05/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 COFFEE RD SUITE 3
MODESTO CA
95355-1344
US

IV. Provider business mailing address

1917 COFFEE RD
MODESTO CA
95355-2704
US

V. Phone/Fax

Practice location:
  • Phone: 209-342-2300
  • Fax: 209-524-4240
Mailing address:
  • Phone: 209-342-2300
  • Fax: 209-524-4240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT16496
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: