Healthcare Provider Details

I. General information

NPI: 1255008041
Provider Name (Legal Business Name): KIANA RENAE CUPPLES PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2021
Last Update Date: 11/02/2026
Certification Date: 11/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4920 CAMPUS DRIVE SUITE B
NEWPORT BEACH CA
92660-3119
US

IV. Provider business mailing address

3230 E. IMPERIAL HWY SUITE 100
BREA CA
92821-6735
US

V. Phone/Fax

Practice location:
  • Phone: 949-271-0053
  • Fax: 949-271-9453
Mailing address:
  • Phone: 714-988-8110
  • Fax: 714-988-8111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number300652
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: