Provider Demographics
NPI:1902154453
Name:KOPIECKI, JANET RAYNES (LMT)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:RAYNES
Last Name:KOPIECKI
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 SHERMAN AVE
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94945-3244
Mailing Address - Country:US
Mailing Address - Phone:415-858-4476
Mailing Address - Fax:
Practice Address - Street 1:920 SHERMAN AVE
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94945-3244
Practice Address - Country:US
Practice Address - Phone:415-858-4476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-15
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18010225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist