Provider Demographics
NPI:1588718365
Name:COPELIN, CYNTHIA D (PT)
Entity type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:D
Last Name:COPELIN
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 1:8119 WILLOW WAY
Mailing Address - Street 2:
Mailing Address - City:RAYTOWN
Mailing Address - State:MO
Mailing Address - Zip Code:64138-2293
Mailing Address - Country:US
Mailing Address - Phone:816-356-6361
Mailing Address - Fax:
Practice Address - Street 1:8119 WILLOW WAY
Practice Address - Street 2:
Practice Address - City:RAYTOWN
Practice Address - State:MO
Practice Address - Zip Code:64138-2293
Practice Address - Country:US
Practice Address - Phone:816-547-7967
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMO R0210225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist