Doctor Name: | SHANNON R ZERDECKI KOPCZA |
NPI Number: | 1811207657 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PT |
License Number: | 019482-1 |
Business Practice Address: | 1 Marauder Blvd New York Mills, NY - 134171566 |
Business Phone Number: | 3157688129 |
Business Fax Number: | |
Mailing Address: | Po Box 381, NEW HARTFORD |
State: | NY |
Postal Code: | 134130381 |
Phone Number: | 3157326911 |
Fax Number: | |
NPI Enumeration Date: | 10/14/2010 |
NPI Last Update Date: | 10/14/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 2251P0200X |
License Number: | 019482-1 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Physical Therapist |
Taxonomy Specialization: | Pediatrics |
Taxonomy Definition: |