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General NPI Number Information
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NPI Number | 1689513004
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Entity Type | Individual
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Provider Name | KEITH COPPER JR.
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Gender | Male
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Dates
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Enumeration Date | 03/28/2026
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Last Update Date | 03/28/2026
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Provider Practice Location Address
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Address Line | 109 PENNY RD
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City | HIGH POINT
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State | NC
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Zip | 27260-2500
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Country | US
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Telephone | 336-821-4050
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Fax |
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Provider Business Mailing Address
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Address Line | 3721 QUEENSWOOD LN
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City | JAMESTOWN
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State | NC
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Zip | 27282-9589
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Country | US
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Telephone |
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | A8754
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License Number State | NC
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