Healthcare Provider Details

I. General information

NPI: 1801074828
Provider Name (Legal Business Name): JOAN MARIE KOPACZ PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JOAN MARIE WARD PT

II. Dates (important events)

Enumeration Date: 01/31/2008
Last Update Date: 03/05/2025
Certification Date: 03/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 19TH ST NW SUITE 200
ROCHESTER MN
55901-6606
US

IV. Provider business mailing address

PO BOX 7197
ROCHESTER MN
55903-7197
US

V. Phone/Fax

Practice location:
  • Phone: 507-322-3460
  • Fax: 507-322-3450
Mailing address:
  • Phone: 507-322-3460
  • Fax: 507-322-3450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number6520
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number6520
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: