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General NPI Number Information
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NPI Number | 1255426631
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Entity Type | Individual
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Provider Name | ERIC KOPP PT,OMT,OCS,FAAOMPT
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Gender | Male
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 03/05/2018
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Provider Practice Location Address
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Address Line | 3 FARM GLEN BLVD
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City | FARMINGTON
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State | CT
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Zip | 06032-1981
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Country | US
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Telephone | 860-284-9780
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Fax | 860-409-9177
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Provider Business Mailing Address
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Address Line | 210 COMMERCE WAY STE 120
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City | PORTSMOUTH
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State | NH
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Zip | 03801-8200
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Country | US
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Telephone | 603-427-8066
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Fax | 603-501-0495
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 007117
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License Number State | CT
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