Provider Demographics
NPI:1972803773
Name:COPPOLINO, FRANK T JR (CP)
Entity Type:Individual
Prefix:MR
First Name:FRANK
Middle Name:T
Last Name:COPPOLINO
Suffix:JR
Gender:M
Credentials:CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5425 REGENCY WOODS MNR
Mailing Address - Street 2:
Mailing Address - City:IMPERIAL
Mailing Address - State:MO
Mailing Address - Zip Code:63052-1971
Mailing Address - Country:US
Mailing Address - Phone:812-589-2069
Mailing Address - Fax:
Practice Address - Street 1:5425 REGENCY WOODS MNR
Practice Address - Street 2:
Practice Address - City:IMPERIAL
Practice Address - State:MO
Practice Address - Zip Code:63052-1971
Practice Address - Country:US
Practice Address - Phone:812-589-2069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-26
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist