Individual
THERESA KOPPAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2940 E BANNER GATEWAY DR STE 200-250, GILBERT, AZ 85234-2168
(602) 548-5444
(602) 772-3801
Mailing address
PO BOX 80217, PHOENIX, AZ 85060-0217
(602) 385-2115
(480) 418-3323
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5748
AZ
363AS0400X
Surgical Physician Assistant
5748
AZ
Other
Enumeration date
09/15/2014
Last updated
07/29/2022
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