Healthcare Provider Details

I. General information

NPI: 1598337156
Provider Name (Legal Business Name): VANESSA KOPANIAK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2021
Last Update Date: 07/13/2021
Certification Date: 07/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19400 108TH AVE SE STE 100
KENT WA
98031-0108
US

IV. Provider business mailing address

11711 NE 12TH ST STE 3A
BELLEVUE WA
98005-2461
US

V. Phone/Fax

Practice location:
  • Phone: 425-917-9887
  • Fax: 253-277-0739
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: