Active NPI
Peter G Coppola, P. T.
- Physical Therapist
- Portland, OR
National Provider Identifier
1851355044
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 60861
- Practice address
- 6504 NE Siskiyou St
Portland, OR 97213-4572 - Phone
- (503) 893-8987
- NPI assigned
- Apr 14, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 60861 | OR | Primary |
Addresses
Primary practice location
6504 NE Siskiyou St
Portland, OR 97213-4572
Mailing address
3024 NE 67TH Ave
Portland, OR 97213-5204
Phone (503) 893-8987
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 60861 | OR | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1144972800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1546041600000",
"number": "1851355044",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3024 NE 67TH AVE",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972135204",
"telephone_number": "503-893-8987"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6504 NE SISKIYOU ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972134572",
"telephone_number": "503-893-8987"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COPPOLA",
"first_name": "PETER",
"middle_name": "G",
"name_prefix": "Mr.",
"credential": "P. T.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-04-14",
"last_updated": "2018-12-29",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "OR",
"license": "60861",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.