Provider Demographics
NPI:1063025849
Name:COPUS, KENIDI LYNNE (DPT)
Entity Type:Individual
Prefix:MRS
First Name:KENIDI
Middle Name:LYNNE
Last Name:COPUS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KENIDI
Other - Middle Name:LYNNE
Other - Last Name:ULM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 239
Mailing Address - Street 2:
Mailing Address - City:FINDLAY
Mailing Address - State:OH
Mailing Address - Zip Code:45839-0239
Mailing Address - Country:US
Mailing Address - Phone:419-422-5526
Mailing Address - Fax:
Practice Address - Street 1:7630 KINGS POINTE RD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43617-1500
Practice Address - Country:US
Practice Address - Phone:419-517-7538
Practice Address - Fax:419-517-7539
Is Sole Proprietor?:No
Enumeration Date:2020-08-31
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT.018815225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist