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General NPI Number Information
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NPI Number | 1528958451
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Entity Type | Individual
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Provider Name | MEREDITH COPETILLO
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Gender | Female
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Dates
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Enumeration Date | 07/03/2025
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Last Update Date | 07/03/2025
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Provider Practice Location Address
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Address Line | 801 POLE LINE RD W
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City | TWIN FALLS
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State | ID
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Zip | 83301-5810
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Country | US
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Telephone | 208-814-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 2315 SALCEDO AVE
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City | SAVANNAH
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State | GA
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Zip | 31406-4243
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Country | US
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Telephone | 912-433-8632
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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 | PT016582
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 2371464
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License Number State | ID
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