Provider Demographics
NPI:1548660772
Name:COPPOTELLI, LISA A (PT, DPT)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:A
Last Name:COPPOTELLI
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:A
Other - Last Name:MEYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:8902 N MERIDIAN ST
Mailing Address - Street 2:STE 215
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-5382
Mailing Address - Country:US
Mailing Address - Phone:317-581-1890
Mailing Address - Fax:
Practice Address - Street 1:320 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:IN
Practice Address - Zip Code:46074-9493
Practice Address - Country:US
Practice Address - Phone:317-867-3206
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-25
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05011504A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist