Provider Demographics
NPI:1164242707
Name:KOPP, RITA ANN (PT)
Entity type:Individual
Prefix:
First Name:RITA
Middle Name:ANN
Last Name:KOPP
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:RITA
Other - Middle Name:ANN
Other - Last Name:HEMMESCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1020 LARK ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:MN
Mailing Address - Zip Code:56308-2219
Mailing Address - Country:US
Mailing Address - Phone:320-763-1125
Mailing Address - Fax:
Practice Address - Street 1:1020 LARK ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:MN
Practice Address - Zip Code:56308-2219
Practice Address - Country:US
Practice Address - Phone:320-763-1125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-16
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN58312251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics