Provider Demographics
NPI:1467484683
Name:COPPOLA, STEVEN (MS, PT)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:
Last Name:COPPOLA
Suffix:
Gender:M
Credentials:MS, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 WOOD HEAD CIRCLE
Mailing Address - Street 2:
Mailing Address - City:LEE
Mailing Address - State:NH
Mailing Address - Zip Code:03824
Mailing Address - Country:US
Mailing Address - Phone:603-659-6273
Mailing Address - Fax:
Practice Address - Street 1:171 PLEASANT STREET
Practice Address - Street 2:STE 101
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301
Practice Address - Country:US
Practice Address - Phone:603-228-7500
Practice Address - Fax:603-228-3503
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2164225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30393244Medicaid
5204192OtherCIGNA
AA22614OtherHARVARD PILGRIM
7052413OtherAETNA
0805655Y0NH02OtherBLUE CROSS BLUE SHIELD
2153224OtherHCVM
5366524OtherCCN
7052413OtherAETNA