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General NPI Number Information
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NPI Number | 1730456153
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Entity Type | Individual
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Provider Name | NICOLE COPELAND PT
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Gender | Female
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Dates
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Enumeration Date | 11/30/2011
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Last Update Date | 11/22/2019
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Provider Practice Location Address
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Address Line | 61 E MAIN ST
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City | MCCONNELSVILLE
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State | OH
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Zip | 43756-1180
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Country | US
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Telephone | 740-962-4441
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Fax | 740-962-4488
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Provider Business Mailing Address
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Address Line | 1500 GRAND CENTRAL AVE STE 101
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City | VIENNA
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State | WV
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Zip | 26105-1079
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Country | US
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Telephone | 304-693-2781
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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 | PT013538
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License Number State | OH
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