Provider Demographics
NPI:1598991630
Name:KOPP, LAURIE ANNE (PT)
Entity Type:Individual
Prefix:MRS
First Name:LAURIE
Middle Name:ANNE
Last Name:KOPP
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 1:16398 OAK HILL DR
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48430-9091
Mailing Address - Country:US
Mailing Address - Phone:810-240-4527
Mailing Address - Fax:
Practice Address - Street 1:2600 UNION LAKE RD
Practice Address - Street 2:SUITE 120
Practice Address - City:COMMERCE TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48382-3588
Practice Address - Country:US
Practice Address - Phone:248-366-1118
Practice Address - Fax:248-366-1011
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-03
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501008947225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist