Provider Demographics
NPI:1366882649
Name:KOPP, JASON DANIEL (ATC)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:DANIEL
Last Name:KOPP
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3140 CHOWEN AVE S
Mailing Address - Street 2:APT 316W
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55416-4533
Mailing Address - Country:US
Mailing Address - Phone:608-732-7458
Mailing Address - Fax:
Practice Address - Street 1:7872 CENTURY BLVD
Practice Address - Street 2:
Practice Address - City:CHANHASSEN
Practice Address - State:MN
Practice Address - Zip Code:55317-8005
Practice Address - Country:US
Practice Address - Phone:952-448-9081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-01
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN24382255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer