Provider Demographics
NPI:1609179993
Name:COPES, TAMARA LAYNE (PT, DPT, MS, ATC)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:LAYNE
Last Name:COPES
Suffix:
Gender:F
Credentials:PT, DPT, MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6600 VAN AALST BLVD BLDG 9250
Mailing Address - Street 2:
Mailing Address - City:FORT MOORE
Mailing Address - State:GA
Mailing Address - Zip Code:31905-2102
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4565 8TH SPECIAL FORCES WAY
Practice Address - Street 2:
Practice Address - City:EGLIN AFB
Practice Address - State:FL
Practice Address - Zip Code:32542-1701
Practice Address - Country:US
Practice Address - Phone:850-885-7981
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-08
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT25861225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY09SGOtherFLORIDA BLUE
FLFT631XMedicare PIN
FLFT631ZMedicare PIN