Provider Demographics
NPI:1578885711
Name:KOPSICK, DAMARIS PEREZ (PT)
Entity Type:Individual
Prefix:MRS
First Name:DAMARIS
Middle Name:PEREZ
Last Name:KOPSICK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4016 GRANT ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-5337
Mailing Address - Country:US
Mailing Address - Phone:954-894-5211
Mailing Address - Fax:
Practice Address - Street 1:8500 W SUNRISE BLVD
Practice Address - Street 2:APT. # 316
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33322-4017
Practice Address - Country:US
Practice Address - Phone:954-472-2890
Practice Address - Fax:954-472-2895
Is Sole Proprietor?:No
Enumeration Date:2010-02-15
Last Update Date:2010-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL7080225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist