Provider Demographics
NPI:1336896802
Name:COPELAND, NATHAN (PT, DPT)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:
Last Name:COPELAND
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2010 W KATHERINE P RAINES RD STE 300
Mailing Address - Street 2:
Mailing Address - City:CLEBURNE
Mailing Address - State:TX
Mailing Address - Zip Code:76033-7447
Mailing Address - Country:US
Mailing Address - Phone:817-556-3212
Mailing Address - Fax:817-645-9845
Practice Address - Street 1:2010 W KATHERINE P RAINES RD STE 400
Practice Address - Street 2:
Practice Address - City:CLEBURNE
Practice Address - State:TX
Practice Address - Zip Code:76033-7458
Practice Address - Country:US
Practice Address - Phone:817-556-3212
Practice Address - Fax:817-645-9845
Is Sole Proprietor?:No
Enumeration Date:2022-03-04
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1254936225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist