Healthcare Provider Details

I. General information

NPI: 1306881966
Provider Name (Legal Business Name): TROY ANDREW COPPUS MS, ATC, CSCS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 06/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 LINCOLN AVE UNIVERSITY OF EVANSVILLE
EVANSVILLE IN
47714-1506
US

IV. Provider business mailing address

625 S ROTHERWOOD AVE
EVANSVILLE IN
47714-2001
US

V. Phone/Fax

Practice location:
  • Phone: 812-488-2202
  • Fax:
Mailing address:
  • Phone: 812-661-9401
  • Fax: 812-488-2199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number36001437A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: