Provider Demographics
NPI:1265083794
Name:KOPECHEK, NATHAN ANTHONY (DPT,PT)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:ANTHONY
Last Name:KOPECHEK
Suffix:
Gender:M
Credentials:DPT,PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22827 VINE CT
Mailing Address - Street 2:
Mailing Address - City:ROCKY RIVER
Mailing Address - State:OH
Mailing Address - Zip Code:44116-3772
Mailing Address - Country:US
Mailing Address - Phone:440-773-6897
Mailing Address - Fax:
Practice Address - Street 1:22827 VINE CT
Practice Address - Street 2:
Practice Address - City:ROCKY RIVER
Practice Address - State:OH
Practice Address - Zip Code:44116-3772
Practice Address - Country:US
Practice Address - Phone:440-773-6897
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-25
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist