Provider Demographics
NPI:1346518230
Name:COPPER COUNTRY PHYSICAL THERAPY
Entity Type:Organization
Organization Name:COPPER COUNTRY PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:J
Authorized Official - Last Name:SMYTHE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:906-231-5029
Mailing Address - Street 1:21710 PEEPSOCK CIR
Mailing Address - Street 2:
Mailing Address - City:HOUGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:49931-1050
Mailing Address - Country:US
Mailing Address - Phone:906-231-5029
Mailing Address - Fax:
Practice Address - Street 1:21710 PEEPSOCK CIR
Practice Address - Street 2:
Practice Address - City:HOUGHTON
Practice Address - State:MI
Practice Address - Zip Code:49931-1050
Practice Address - Country:US
Practice Address - Phone:906-231-5029
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-06
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501005153225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty