Individual provider Active NPI

Matthew Tucker Coppage, DPT

  • Physical Therapist
  • Johns Creek, GA
National Provider Identifier
1114657079
Registry record updated Jun 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT015892 Issued in GA
Practice address
11720 Medlock Bridge Rd Ste 550
Johns Creek, GA 30097-2505
Phone
(678) 364-7195
NPI assigned
Jun 14, 2022
Last updated
Jun 14, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 14, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PT015892 GA Primary

Addresses

Primary practice location

11720 Medlock Bridge Rd Ste 550
Johns Creek, GA 30097-2505

Mailing address

6397 Lee Hwy Ste 300
Chattanooga, TN 37421-4915
Phone (423) 238-8923

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220714000092 GA Practitioner - Physical Therapist in Private Practice 5193106730 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1205 Johnson Ferry Rd
Suite 130
Marietta, GA 30068-5401
Phone (770) 565-3201

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Benchmark Physical Therapy, Inc CurrentSince Jun 20, 2022 Accepting new patients
Independent Physical Therapy of Georgia, LLC Physical Therapist CurrentSince Jun 20, 2022 Accepting new patients
Agilitas USA, Inc Physical Therapist CurrentSince Jun 20, 2022 Accepting new patients
Benchmark Physical Therapy, Inc CurrentSince Jun 20, 2022 Accepting new patients
Independent Physical Therapy of Georgia, LLC Physical Therapist CurrentSince Jun 20, 2022 Accepting new patients
Agilitas USA Inc Physical Therapist CurrentSince Jun 20, 2022 Accepting new patients
Drayer Physical Therapy Georgia LLC Physical Therapist CurrentSince Jun 20, 2022 Accepting new patients

Locations

1200 Corporate Dr
Ste 400
Hoover, AL 35242
Phone (423) 238-7568

1025 E West Connector
Ste 406
Austell, GA 30106
Phone (770) 384-1001

11720 Medlock Bridge Rd
Ste 550
Johns Creek, GA 30097
Phone (678) 364-7195

7130 Mount Zion Blvd
Ste 9
Jonesboro, GA 30236
Phone (770) 603-5660

3455 Highway 81
Loganville, GA 30052
Phone (678) 635-8280

1205 Johnson Ferry Rd
Ste 130
Marietta, GA 30068
Phone (770) 565-3201

10800 Alpharetta Hwy
Ste 176
Roswell, GA 30076
Phone (678) 364-7195

1615 State Highway 17
Ste 9
Young Harris, GA 30582
Phone (706) 896-2771

6397 Lee Hwy
Ste 300
Chattanooga, TN 37421
Phone (423) 238-8923

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1655164800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655164800000",
    "number": "1114657079",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6397 LEE HWY STE 300",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "374214915",
            "telephone_number": "423-238-8923"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11720 MEDLOCK BRIDGE RD STE 550",
            "city": "JOHNS CREEK",
            "state": "GA",
            "postal_code": "300972505",
            "telephone_number": "678-364-7195"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COPPAGE",
        "first_name": "MATTHEW",
        "middle_name": "TUCKER",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-06-14",
        "last_updated": "2022-06-14",
        "certification_date": "2022-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "GA",
            "license": "PT015892",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Johns Creek, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.