Provider Demographics
NPI:1245088095
Name:COPE, ELIZABETH A (LMT)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:A
Last Name:COPE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42459 HIGHWAY 200 # 13
Mailing Address - Street 2:
Mailing Address - City:HOPE
Mailing Address - State:ID
Mailing Address - Zip Code:83836-9784
Mailing Address - Country:US
Mailing Address - Phone:352-601-7343
Mailing Address - Fax:
Practice Address - Street 1:30410 HIGHWAY 200 STE 100
Practice Address - Street 2:
Practice Address - City:PONDERAY
Practice Address - State:ID
Practice Address - Zip Code:83852-9601
Practice Address - Country:US
Practice Address - Phone:208-263-3211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-07
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDMAS3793225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist