Healthcare Provider Details

I. General information

NPI: 1952310690
Provider Name (Legal Business Name): KEVIN M COPE PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 11/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 OAKWOOD DR STE B
MADISON HEIGHTS VA
24572-3001
US

IV. Provider business mailing address

20347 TIMBERLAKE RD STE B
LYNCHBURG VA
24502-7352
US

V. Phone/Fax

Practice location:
  • Phone: 434-845-9053
  • Fax: 434-528-2788
Mailing address:
  • Phone: 434-845-9054
  • Fax: 434-528-2788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305001659
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: