Healthcare Provider Details

I. General information

NPI: 1821438128
Provider Name (Legal Business Name): KIRSTEN ARIEL KUPRAS P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2013
Last Update Date: 07/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9280 W STOCKTON BLVD SUITE 116
ELK GROVE CA
95758-8073
US

IV. Provider business mailing address

10470 OLD PLACERVILLE RD SUITE 100
SACRAMENTO CA
95827-2539
US

V. Phone/Fax

Practice location:
  • Phone: 916-683-2580
  • Fax: 916-683-1579
Mailing address:
  • Phone: 800-470-0071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40192
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: