Provider Demographics
NPI:1083676423
Name:COPELAND, CHAD (MPT)
Entity Type:Individual
Prefix:MR
First Name:CHAD
Middle Name:
Last Name:COPELAND
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 LAWNSDALE VW
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:WV
Mailing Address - Zip Code:26105-1559
Mailing Address - Country:US
Mailing Address - Phone:304-295-5195
Mailing Address - Fax:
Practice Address - Street 1:1158 46TH ST
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:WV
Practice Address - Zip Code:26105-9409
Practice Address - Country:US
Practice Address - Phone:304-295-3131
Practice Address - Fax:304-295-0700
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV002015225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV4229061Medicare PIN