Provider Demographics
NPI:1457712259
Name:KOPEC, JASON PAUL (MS, ATC)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:PAUL
Last Name:KOPEC
Suffix:
Gender:M
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 SPICEBUSH CT
Mailing Address - Street 2:
Mailing Address - City:SICKLERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08081-1647
Mailing Address - Country:US
Mailing Address - Phone:856-904-6988
Mailing Address - Fax:
Practice Address - Street 1:101 APPLIED BANK BLVD
Practice Address - Street 2:SUITE #8-11
Practice Address - City:GLEN MILLS
Practice Address - State:PA
Practice Address - Zip Code:19342-3501
Practice Address - Country:US
Practice Address - Phone:484-800-8740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-08
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0039922255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer