Provider Demographics
NPI:1629345202
Name:KOPKA, ROCHELLE (DPT)
Entity type:Individual
Prefix:MRS
First Name:ROCHELLE
Middle Name:
Last Name:KOPKA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1838 N 9 MILE RD
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48657-9694
Mailing Address - Country:US
Mailing Address - Phone:989-751-5950
Mailing Address - Fax:
Practice Address - Street 1:16351 ROTUNDA DR APT 157
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48120-1182
Practice Address - Country:US
Practice Address - Phone:734-718-2947
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-25
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501013369225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist