Provider Demographics
NPI:1467816017
Name:COPE, ROSE (PTA)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:
Last Name:COPE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:ROSE
Other - Middle Name:
Other - Last Name:RAINEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:18 GROVE PARK CIR
Mailing Address - Street 2:
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30120-8472
Mailing Address - Country:US
Mailing Address - Phone:706-331-8194
Mailing Address - Fax:
Practice Address - Street 1:809 S BROAD ST SW
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30161-4654
Practice Address - Country:US
Practice Address - Phone:706-235-1337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-11
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPTA003592225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant