Provider Demographics
NPI:1396855102
Name:KOPF, KATHRYN MARIE (PT)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:MARIE
Last Name:KOPF
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:MARIE
Other - Last Name:RICHMOND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:3010 WEST LAKE RD
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16505-3849
Mailing Address - Country:US
Mailing Address - Phone:814-833-2022
Mailing Address - Fax:814-838-1223
Practice Address - Street 1:4500 PINE AVE
Practice Address - Street 2:SUITE A
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16504-2342
Practice Address - Country:US
Practice Address - Phone:814-825-8900
Practice Address - Fax:814-825-7599
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT001112225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA091357RYZMedicare ID - Type Unspecified
PA091357R5DMedicare ID - Type UnspecifiedMEDICARE ID NUMBER