Provider Demographics
NPI:1316461205
Name:KOPIN, KIMBERLY (DPT)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:KOPIN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 MELROSE AVE
Mailing Address - Street 2:
Mailing Address - City:HADDON TWP
Mailing Address - State:NJ
Mailing Address - Zip Code:08108-2406
Mailing Address - Country:US
Mailing Address - Phone:856-547-4422
Mailing Address - Fax:856-547-0660
Practice Address - Street 1:50 E GLOUCESTER PIKE
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08007-1323
Practice Address - Country:US
Practice Address - Phone:856-547-4422
Practice Address - Fax:856-547-0660
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-01
Last Update Date:2017-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01510500225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty