Provider Demographics
NPI:1922420389
Name:COPPEDGE, CHRISTOPHER (LMT)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:COPPEDGE
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4045 WADSWORTH BLVD
Mailing Address - Street 2:SUITE 270
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-4642
Mailing Address - Country:US
Mailing Address - Phone:303-482-2588
Mailing Address - Fax:720-389-6499
Practice Address - Street 1:4045 WADSWORTH BLVD
Practice Address - Street 2:SUITE 270
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-4642
Practice Address - Country:US
Practice Address - Phone:303-482-2588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-20
Last Update Date:2014-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0014398225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist