Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 7549 | OH |
NPI | 1023434560 |
---|---|
Provider Name | Mrs. Lisa Copenhaver |
First Address | Marietta, OH 45750-9700 |
Second Address | Marietta, OH 45750-9700 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2014 |
Last Update Date | 07/03/2014 |