Healthcare Provider Details

I. General information

NPI: 1093285298
Provider Name (Legal Business Name): KATHLEEN KOPALE DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2018
Last Update Date: 11/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4440 W 95TH ST
OAK LAWN IL
60453-2600
US

IV. Provider business mailing address

10330 S CAMPBELL AVE
CHICAGO IL
60655-1017
US

V. Phone/Fax

Practice location:
  • Phone: 708-684-5369
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070.023426
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: