Provider Demographics
NPI:1114374683
Name:KOPOTIC, CURTIS (ATC)
Entity Type:Individual
Prefix:
First Name:CURTIS
Middle Name:
Last Name:KOPOTIC
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17094 LUPINE LN
Mailing Address - Street 2:
Mailing Address - City:BIG LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55309-4646
Mailing Address - Country:US
Mailing Address - Phone:619-955-9249
Mailing Address - Fax:
Practice Address - Street 1:17094 LUPINE LN
Practice Address - Street 2:
Practice Address - City:BIG LAKE
Practice Address - State:MN
Practice Address - Zip Code:55309-4646
Practice Address - Country:US
Practice Address - Phone:619-955-9249
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-15
Last Update Date:2016-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN26642255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer