Provider Demographics
NPI:1427100999
Name:COPPOLA, LISA C (PT)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:C
Last Name:COPPOLA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 SCHOOL LN
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19403-3162
Mailing Address - Country:US
Mailing Address - Phone:610-630-4057
Mailing Address - Fax:
Practice Address - Street 1:280 SCHOOL LN
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:PA
Practice Address - Zip Code:19403-3162
Practice Address - Country:US
Practice Address - Phone:610-630-4057
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT003671L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA046106PQXMedicare ID - Type Unspecified