Provider Demographics
NPI:1457449084
Name:COPPA, KRISTY LYNN (LMP)
Entity Type:Individual
Prefix:
First Name:KRISTY
Middle Name:LYNN
Last Name:COPPA
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:20833 67TH AVE W
Mailing Address - Street 2:SUITE 301
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-7365
Mailing Address - Country:US
Mailing Address - Phone:425-771-5620
Mailing Address - Fax:425-774-4735
Practice Address - Street 1:20833 67TH AVE W
Practice Address - Street 2:SUITE 301
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-7365
Practice Address - Country:US
Practice Address - Phone:425-771-5620
Practice Address - Fax:425-774-4735
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00020565225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist