Healthcare Provider Details

I. General information

NPI: 1376458497
Provider Name (Legal Business Name): SAMUEL COPPOLINO DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1395A COMMERCE WAY
ATTLEBORO MA
02703-4693
US

IV. Provider business mailing address

4 RICHMOND SQ STE 400
PROVIDENCE RI
02906-5117
US

V. Phone/Fax

Practice location:
  • Phone: 508-455-5740
  • Fax: 508-455-5945
Mailing address:
  • Phone: 401-433-4172
  • Fax: 401-433-6012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTL89792
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: