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General NPI Number Information
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NPI Number | 1346518230
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Entity Type | Organization
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Legal Business Name | COPPER COUNTRY PHYSICAL THERAPY
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Dates
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Enumeration Date | 12/06/2011
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Last Update Date | 12/06/2011
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Provider Practice Location Address
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Address Line | 21710 PEEPSOCK CIR
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City | HOUGHTON
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State | MI
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Zip | 49931-1050
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Country | US
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Telephone | 906-231-5029
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Fax |
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Provider Business Mailing Address
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Address Line | 21710 PEEPSOCK CIR
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City | HOUGHTON
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State | MI
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Zip | 49931-1050
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Country | US
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Telephone | 906-231-5029
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | PHILIP J SMYTHE
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Credential |
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Telephone | 906-231-5029
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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 | 5501005153
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License Number State | MI
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