1093380156 NPI number — MRS. EMILY ANN KUPPER PT, DPT

Table of content: MRS. EMILY ANN KUPPER PT, DPT (NPI 1093380156)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093380156 NPI number — MRS. EMILY ANN KUPPER PT, DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KUPPER
Provider First Name:
EMILY
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PT, DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LOWE
Provider Other First Name:
EMILY
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
EMILY LOWE
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1093380156
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/29/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
363 PEMBROKE ST, LEHIGH ACRES, FL.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEHIGH ACRES
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33974-9571
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
239-297-8654
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2724 5TH ST W STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEHIGH ACRES
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33971-1581
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
239-303-1501
Provider Business Practice Location Address Fax Number:
888-803-9101
Provider Enumeration Date:
05/21/2021

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2251X0800X , with the licence number:  PT37150 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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