Active NPI
Mary Michele Coppola, PT
- Physical Therapist
- Massapequa, NY
National Provider Identifier
1912988015
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 5628
- Practice address
- 700 Broadway
Massapequa, NY 11758-2324 - Phone
- (516) 797-7003
- Fax
- (516) 797-7336
- NPI assigned
- Nov 7, 2005
- Sex
- Female
- 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 | 5628 | NY | Primary |
Addresses
Primary practice location
700 Broadway
Massapequa, NY 11758-2324
Mailing address
501 N 7TH St
New Hyde Park, NY 11040-3028
Phone (516) 775-7046
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 122805 | Other | NY | VYTRA |
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 |
|---|---|---|---|
| 5628 | NY | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1131321600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1912988015",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "501 N 7TH ST",
"city": "NEW HYDE PARK",
"state": "NY",
"postal_code": "110403028",
"telephone_number": "516-775-7046",
"fax_number": "516-797-7336"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "700 BROADWAY",
"city": "MASSAPEQUA",
"state": "NY",
"postal_code": "117582324",
"telephone_number": "516-797-7003",
"fax_number": "516-797-7336"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COPPOLA",
"first_name": "MARY",
"middle_name": "MICHELE",
"name_prefix": "Ms.",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-11-07",
"last_updated": "2026-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NY",
"license": "5628",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VYTRA",
"identifier": "122805",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Massapequa, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.