Provider Demographics
NPI:1134451743
Name:KOPF, DONNA LEE (LMT, MMP)
Entity type:Individual
Prefix:MS
First Name:DONNA
Middle Name:LEE
Last Name:KOPF
Suffix:
Gender:F
Credentials:LMT, MMP
Other - Prefix:MRS
Other - First Name:DONNA
Other - Middle Name:LEE
Other - Last Name:EVELAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CMT, MMP
Mailing Address - Street 1:106 AERO VISTA LN
Mailing Address - Street 2:
Mailing Address - City:KINGSLAND
Mailing Address - State:TX
Mailing Address - Zip Code:78639-4302
Mailing Address - Country:US
Mailing Address - Phone:830-201-0301
Mailing Address - Fax:
Practice Address - Street 1:3839 BEE CAVES RD
Practice Address - Street 2:SUITE 202
Practice Address - City:WEST LAKE HILLS
Practice Address - State:TX
Practice Address - Zip Code:78746-6401
Practice Address - Country:US
Practice Address - Phone:830-201-0301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-06
Last Update Date:2010-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT109897225700000X
VA0019005614225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist