Provider Demographics
NPI:1417338187
Name:COPLEY, AMANDA (PTA)
Entity Type:Individual
Prefix:MISS
First Name:AMANDA
Middle Name:
Last Name:COPLEY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 1/2 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SHILOH
Mailing Address - State:OH
Mailing Address - Zip Code:44878-9749
Mailing Address - Country:US
Mailing Address - Phone:567-224-6257
Mailing Address - Fax:
Practice Address - Street 1:91 1/2 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SHILOH
Practice Address - State:OH
Practice Address - Zip Code:44878-9749
Practice Address - Country:US
Practice Address - Phone:567-224-6257
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-17
Last Update Date:2015-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPTA.07647225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant