Provider Demographics
NPI:1336187665
Name:COPES, KENNETH STUART (PT)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:STUART
Last Name:COPES
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:788 PRINCE AVE
Mailing Address - Street 2:STE C
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-5912
Mailing Address - Country:US
Mailing Address - Phone:706-543-2111
Mailing Address - Fax:706-543-2190
Practice Address - Street 1:1765 OLD WEST BROAD ST
Practice Address - Street 2:BLDG 1 SUITE 100
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-2867
Practice Address - Country:US
Practice Address - Phone:706-543-2111
Practice Address - Fax:706-543-2190
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-02
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT004796225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAQ47476Medicare UPIN
GAGRP7220Medicare ID - Type Unspecified