Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports | 015412 | OH |
NPI | 1215571195 |
---|---|
Provider Name | Patricia Mariano Kopasakis |
First Address | Avon, OH 44011-1390 |
Second Address | Avon, OH 44011-1390 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/11/2019 |
Last Update Date | 04/11/2019 |