MEDICARE: MRS. JOAN MARIE KOPACZ PT

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	2251S0007X	Sports Physical Therapist	6520	MN
2	2251X0800X	Orthopedic Physical Therapist	6520	MN

General Provider Information

NPI Number	:	1801074828
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JOAN MARIE KOPACZ PT

Provider Business Mailing Address
First Line	:	PO BOX 7197
Second Line	:
City	:	ROCHESTER
State	:	MN
Zip	:	55903-7197
Country	:	US
Telephone Number	:	507-322-3460
Fax Number	:	507-322-3450

Provider Business Practice Location Address
First Line	:	3100 19TH ST NW
Second Line	:	SUITE 200
City	:	ROCHESTER
State	:	MN
Zip	:	55901-6606
Country	:	US
Telephone Number	:	507-322-3460
Fax Number	:	507-322-3450

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/31/2008
Last Update Date	:	03/05/2025

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