CRYSTAL M COPPOLA
Physical Therapist Assistant


Address: 65-11 79th St, Middle Village, NY 11379

CRYSTAL M COPPOLA (Credential# 1423353) is licensed (Physical Therapist Assistant) with Connecticut Department of Consumer Protection. The license effective date is June 2, 2017. The license expiration date date is March 31, 2018. The license status is INACTIVE.

Business Overview

CRYSTAL M COPPOLA is licensed with the Department of Consumer Protection of Connecticut. The credential number is #63.001817. The credential type is physical therapist assistant. The effective date is June 2, 2017. The expiration date is March 31, 2018. The business address is 65-11 79th St, Middle Village, NY 11379. The current status is inactive.

Basic Information

Licensee Name CRYSTAL M COPPOLA
Credential ID 1423353
Credential Number 63.001817
Credential Type Physical Therapist Assistant
Business Address 65-11 79th St
Middle Village
NY 11379
Business Type INDIVIDUAL
Status INACTIVE - LAPSED DUE TO NON-RENEWAL
Issue Date 2017-06-02
Effective Date 2017-06-02
Expiration Date 2018-03-31
Refresh Date 2018-07-04

Office Location

Street Address 65-11 79TH ST
City MIDDLE VILLAGE
State NY
Zip Code 11379

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City MIDDLE VILLAGE
Zip Code 11379
License Type Physical Therapist Assistant
License Type + County Physical Therapist Assistant + MIDDLE VILLAGE

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Dataset Information

Data Provider Connecticut Department of Consumer Protection
Jurisdiction Connecticut
Related Datasets Connecticut Business Registrations, Connecticut Child Care Facilities

This dataset includes 1.41 million licenses issued wtih Connecticut Department of Consumer Protection (TDLR).

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