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Individual

MR. JEFFREY DOUGLAS COPPOCK

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MS PT

Contact information

Practice address
200 NW 4TH ST, BRYANT, AR 72022-3424
(501) 847-5660
Mailing address
9778 SPRINGHILL FARMS DR, ALEXANDER, AR 72002-8998
(501) 588-7674

Taxonomy

Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
OTA936
AR
225100000X
Physical Therapist
Primary
PT2370
AR
225100000X
Physical Therapist
PT2660
AR
225200000X
Physical Therapy Assistant
PTA2715
AR
225X00000X
Occupational Therapist
OTR825
AR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
126978721
AR
05
139676721
AR
05
149815721
AR
05
1619411721
AR
05
197090795
AR
05
211208721
AR
01
5U673
BCBS
AR
Enumeration date
03/23/2006
Last updated
07/31/2019
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