Provider Demographics
NPI:1558692723
Name:COPE-RANDALL, KELLY ANN (PT)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:ANN
Last Name:COPE-RANDALL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23780 US 59 NORTH
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339
Mailing Address - Country:US
Mailing Address - Phone:281-358-1838
Mailing Address - Fax:
Practice Address - Street 1:23780 US 59 NORTH
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339
Practice Address - Country:US
Practice Address - Phone:281-358-1838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8814225100000X
VA2305205551225100000X
TX1291900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ036551OtherMEDICARE PROVIDER NUMBER