Provider Demographics
NPI:1760057806
Name:COPP, WANDA MARIE (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:MS
First Name:WANDA
Middle Name:MARIE
Last Name:COPP
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:558 PERRY HWY FL 2
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15229-1854
Mailing Address - Country:US
Mailing Address - Phone:412-499-4592
Mailing Address - Fax:
Practice Address - Street 1:101 EMERSON PROFESSIONAL BUILDING
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15215-3252
Practice Address - Country:US
Practice Address - Phone:412-499-4592
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-21
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG010449225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty