Provider Demographics
NPI:1114713021
Name:COPELAND, CAROL (PTA)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:COPELAND
Suffix:
Gender:
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 BRIAN LN
Mailing Address - Street 2:
Mailing Address - City:TRUMANN
Mailing Address - State:AR
Mailing Address - Zip Code:72472-1015
Mailing Address - Country:US
Mailing Address - Phone:870-483-3335
Mailing Address - Fax:
Practice Address - Street 1:1825 E NETTLETON AVE STE D
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-5152
Practice Address - Country:US
Practice Address - Phone:870-520-8761
Practice Address - Fax:870-573-8133
Is Sole Proprietor?:No
Enumeration Date:2025-04-17
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPTA1785225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant