Healthcare Provider Details

I. General information

NPI: 1396855102
Provider Name (Legal Business Name): KATHRYN MARIE KOPF PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHRYN MARIE RICHMOND PT

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 PINE AVE SUITE A
ERIE PA
16504-2342
US

IV. Provider business mailing address

3010 WEST LAKE RD
ERIE PA
16505-3849
US

V. Phone/Fax

Practice location:
  • Phone: 814-825-8900
  • Fax: 814-825-7599
Mailing address:
  • Phone: 814-833-2022
  • Fax: 814-838-1223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT001112
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: