Provider Demographics
NPI:1407875784
Name:KOPACZ, JOSEPH GREGORY (ATC, CSCS)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:GREGORY
Last Name:KOPACZ
Suffix:
Gender:M
Credentials:ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3579 JAMES BLVD
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:OH
Mailing Address - Zip Code:44212-2223
Mailing Address - Country:US
Mailing Address - Phone:330-220-2470
Mailing Address - Fax:
Practice Address - Street 1:SOUTHWEST GENERAL HEALTH CENTER
Practice Address - Street 2:18697 BAGLEY ROAD
Practice Address - City:MIDDLEBURG HTS.
Practice Address - State:OH
Practice Address - Zip Code:44130-3497
Practice Address - Country:US
Practice Address - Phone:440-816-8008
Practice Address - Fax:440-816-4850
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT 0008452255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer