Healthcare Provider Details

I. General information

NPI: 1720441652
Provider Name (Legal Business Name): ANDREW J KUPPER PT DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2016
Last Update Date: 10/02/2023
Certification Date: 10/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2546 HEYDON LN STE 4
CAPE CORAL FL
33991-3550
US

IV. Provider business mailing address

2546 HEYDON LN STE 4
CAPE CORAL FL
33991-3550
US

V. Phone/Fax

Practice location:
  • Phone: 239-223-0484
  • Fax: 239-790-0969
Mailing address:
  • Phone: 309-339-1671
  • Fax: 239-790-0969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number34801
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: