Provider Demographics
NPI:1013218130
Name:COPPOTELLI, JANETTE JOYCE MARY (DPT)
Entity Type:Individual
Prefix:
First Name:JANETTE
Middle Name:JOYCE MARY
Last Name:COPPOTELLI
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:JANETTE
Other - Middle Name:JOYCE MARY
Other - Last Name:GLINKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:24630 WASHINGTON AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-6177
Mailing Address - Country:US
Mailing Address - Phone:951-696-9353
Mailing Address - Fax:951-973-7216
Practice Address - Street 1:17270 BEAR VALLEY RD
Practice Address - Street 2:SUITE E-105
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-7751
Practice Address - Country:US
Practice Address - Phone:760-955-6061
Practice Address - Fax:760-955-6062
Is Sole Proprietor?:No
Enumeration Date:2010-11-04
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 35545225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PT355450OtherBLUE SHIELD PIN
CA0PT355450OtherBLUE SHIELD PIN