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General NPI Number Information
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NPI Number | 1306170220
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Entity Type | Individual
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Provider Name | JENNIFER LYNN KOPACH PT, MS
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Gender | Female
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Dates
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Enumeration Date | 09/24/2009
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Last Update Date | 08/03/2018
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Provider Practice Location Address
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Address Line | 3000 JOHNSON FERRY RD STE 110
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City | MARIETTA
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State | GA
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Zip | 30062
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Country | US
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Telephone | 917-334-9108
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Fax |
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Provider Business Mailing Address
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Address Line | 4557 WENDEN LN
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City | MARIETTA
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State | GA
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Zip | 30062-5696
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Country | US
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Telephone | 917-334-9108
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Fax |
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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 | 010961
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License Number State | GA
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