MEDICARE: COPULOS AND ASSOCIATES PHYSICAL THERAPY, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	MT108747	TX
2	225100000X	Physical Therapist	1152018	TX

General Provider Information

NPI Number	:	1447555370
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COPULOS AND ASSOCIATES PHYSICAL THERAPY, INC.

Provider Business Mailing Address
First Line	:	5708 TOSCANA AVE
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78724-6185
Country	:	US
Telephone Number	:	512-659-8090
Fax Number	:	512-926-9997

Provider Business Practice Location Address
First Line	:	3220 MANOR RD
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78723-5721
Country	:	US
Telephone Number	:	512-659-8090
Fax Number	:	512-926-9997

Authorized Official
Title or Position	:	CORPORATE PRESIDENT/OWNER
Name	:	MRS. URSULA K COPULOS
Credential	:	MPT, LMT
Telephone Number	:	512-659-8090

Provider Enumeration Date	:	01/25/2011
Last Update Date	:	01/25/2011

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