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NPI Code Detail

MEDICARE: MRS. JACKLYN COPPOLA PT, DPT

MEDICARE: MRS. JACKLYN COPPOLA PT, DPT
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
1225100000XPhysical Therapist5501017144MI

General Provider Information

NPI Number : 1942667290
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JACKLYN COPPOLA PT, DPT
Provider Business Mailing Address
First Line : 1200 CORPORATE DR STE 400
Second Line :
City : HOOVER
State : AL
Zip : 35242-5424
Country : US
Telephone Number : 423-497-0005
Fax Number :
Provider Business Practice Location Address
First Line : 47284 MICHIGAN AVE
Second Line :
City : CANTON
State : MI
Zip : 48188-2582
Country : US
Telephone Number : 734-418-5237
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/18/2016
Last Update Date : 03/24/2025

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