Provider Demographics
NPI:1508811209
Name:COOPERMAN, JONATHAN MORRIS (DPT MS)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:MORRIS
Last Name:COOPERMAN
Suffix:
Gender:M
Credentials:DPT MS
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:4797 SHERMAN RD
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:OH
Mailing Address - Zip Code:44240
Mailing Address - Country:US
Mailing Address - Phone:330-677-5877
Mailing Address - Fax:330-665-1830
Practice Address - Street 1:3975 EMBASSY PKWY
Practice Address - Street 2:SUITE 103
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44333
Practice Address - Country:US
Practice Address - Phone:330-668-4080
Practice Address - Fax:330-665-1830
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH003053225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2289956Medicaid
S86818Medicare UPIN
OH0887671Medicare ID - Type Unspecified