Provider Demographics
NPI:1639394307
Name:KOPEN, JONATHAN DEAN (PTA)
Entity type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:DEAN
Last Name:KOPEN
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2603 CRESTVIEW DR
Mailing Address - Street 2:
Mailing Address - City:HINCKLEY
Mailing Address - State:OH
Mailing Address - Zip Code:44233-9609
Mailing Address - Country:US
Mailing Address - Phone:330-273-4699
Mailing Address - Fax:
Practice Address - Street 1:555 SPRINGBROOK DR
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-3651
Practice Address - Country:US
Practice Address - Phone:330-725-3393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPTA2509225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant