Provider Demographics
NPI:1114701927
Name:COPPOLA, JENNIFER CATHERINE (DPT)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:CATHERINE
Last Name:COPPOLA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9417 RIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-6710
Mailing Address - Country:US
Mailing Address - Phone:917-671-6287
Mailing Address - Fax:
Practice Address - Street 1:1825 BATH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-4613
Practice Address - Country:US
Practice Address - Phone:718-238-4637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-22
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051047225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist