Provider Demographics
NPI:1134603889
Name:KOPICKI, ALEXANDER THOMAS (DPT)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:THOMAS
Last Name:KOPICKI
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7387 PITTSFORD VICTOR RD STE 950
Mailing Address - Street 2:
Mailing Address - City:VICTOR
Mailing Address - State:NY
Mailing Address - Zip Code:14564-9676
Mailing Address - Country:US
Mailing Address - Phone:585-924-3250
Mailing Address - Fax:
Practice Address - Street 1:7387 PITTSFORD VICTOR RD STE 950
Practice Address - Street 2:
Practice Address - City:VICTOR
Practice Address - State:NY
Practice Address - Zip Code:14564-9676
Practice Address - Country:US
Practice Address - Phone:585-924-3250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-19
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043267-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYPENDINGOtherPENDING