Basic Information
| Provider Information | |||||||||
| NPI: | 1609179993 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COPES | ||||||||
| FirstName: | TAMARA | ||||||||
| MiddleName: | LAYNE | ||||||||
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| Credential: | PT, DPT, MS, ATC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 80 TECHNACENTER DR | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | MONTGOMERY | ||||||||
| State: | AL | ||||||||
| PostalCode: | 361176028 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3346255795 | ||||||||
| FaxNumber: | 3343964905 | ||||||||
| Practice Location | |||||||||
| Address1: | 8199 NAVARRE PKWY | ||||||||
| Address2: | UNIT 12A | ||||||||
| City: | NAVARRE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325666941 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8509391233 | ||||||||
| FaxNumber: | 8509395097 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/08/2010 | ||||||||
| LastUpdateDate: | 03/15/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT25861 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | Y09SG | 01 | FL | FLORIDA BLUE | OTHER |