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NPI Code Detail

MEDICARE: PENNY S COPPERSMITH P.T.

MEDICARE: PENNY S COPPERSMITH P.T.
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
1225100000XPhysical TherapistPT00002380WA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
15345COOTHERWAREGENCE BLUE SHIELD
2151617OTHERWALABOR & INDUSTRIES
35345COOTHERWAREGENCE CARE

General Provider Information

NPI Number : 1528196441
Entity Type Code : Individual
Provider Name (Legal Business Name) : PENNY S COPPERSMITH P.T.
Provider Business Mailing Address
First Line : 611 N 64TH ST
Second Line :
City : SEATTLE
State : WA
Zip : 98103-5631
Country : US
Telephone Number : 206-789-2951
Fax Number :
Provider Business Practice Location Address
First Line : 5025 25TH AVE NE
Second Line : SUITE 201
City : SEATTLE
State : WA
Zip : 98105-4151
Country : US
Telephone Number : 206-524-6702
Fax Number : 206-524-6703
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/01/2007
Last Update Date : 02/01/2008

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Directions to “ PENNY S COPPERSMITH P.T.” Practice Location

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