Provider Demographics
NPI:1104111681
Name:KOPENY, JILL DANIELLE
Entity type:Individual
Prefix:MRS
First Name:JILL
Middle Name:DANIELLE
Last Name:KOPENY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 MISSION ST
Mailing Address - Street 2:
Mailing Address - City:RANCHO SANTA MARGARITA
Mailing Address - State:CA
Mailing Address - Zip Code:92688-3103
Mailing Address - Country:US
Mailing Address - Phone:949-635-9788
Mailing Address - Fax:
Practice Address - Street 1:777 CORPORATE DR
Practice Address - Street 2:STE 160
Practice Address - City:LADERA RANCH
Practice Address - State:CA
Practice Address - Zip Code:92694-2135
Practice Address - Country:US
Practice Address - Phone:949-472-2242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-13
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5590225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant