Provider Demographics
NPI:1306981667
Name:COPELAND, TINA JANE (PT)
Entity type:Individual
Prefix:MS
First Name:TINA
Middle Name:JANE
Last Name:COPELAND
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 HETRICK AVE
Mailing Address - Street 2:
Mailing Address - City:PALMYRA
Mailing Address - State:PA
Mailing Address - Zip Code:17078-3030
Mailing Address - Country:US
Mailing Address - Phone:717-832-1015
Mailing Address - Fax:
Practice Address - Street 1:911 HETRICK AVE
Practice Address - Street 2:
Practice Address - City:PALMYRA
Practice Address - State:PA
Practice Address - Zip Code:17078-3030
Practice Address - Country:US
Practice Address - Phone:717-832-1015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT011528L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019169170002Medicaid