Provider Demographics
NPI:1437660156
Name:KOPKE, JOSEPH VICTOR (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:VICTOR
Last Name:KOPKE
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 SOUTH BLVD APT 1
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-2702
Mailing Address - Country:US
Mailing Address - Phone:719-210-2735
Mailing Address - Fax:
Practice Address - Street 1:1021 SOUTH BLVD APT 1
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-2702
Practice Address - Country:US
Practice Address - Phone:719-210-2735
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-20
Last Update Date:2017-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.023365225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist