Provider Demographics
NPI:1972546752
Name:KOPITZKE, RON L (PT, DPT, OCS)
Entity Type:Individual
Prefix:MR
First Name:RON
Middle Name:L
Last Name:KOPITZKE
Suffix:
Gender:M
Credentials:PT, DPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 GOLDEN CENTER DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-6278
Mailing Address - Country:US
Mailing Address - Phone:530-344-2045
Mailing Address - Fax:530-642-0794
Practice Address - Street 1:4300 GOLDEN CENTER DR
Practice Address - Street 2:SUITE B
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-6278
Practice Address - Country:US
Practice Address - Phone:530-344-2045
Practice Address - Fax:530-642-0794
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT10643225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PT106430Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER