MEDICARE: SARAH J COPPOLA LMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	031880	NY

General Provider Information

NPI Number	:	1659979680
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH J COPPOLA LMT

Provider Business Mailing Address
First Line	:	1100 GOODMAN ST S STE 307
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14620-2530
Country	:	US
Telephone Number	:	716-253-1466
Fax Number	:

Provider Business Practice Location Address
First Line	:	1100 GOODMAN ST S STE 307
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14620-2530
Country	:	US
Telephone Number	:	716-253-1466
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/12/2020
Last Update Date	:	09/13/2023

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