Healthcare Provider Details

I. General information

NPI: 1093380156
Provider Name (Legal Business Name): EMILY ANN KUPPER PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: EMILY ANN LOWE EMILY LOWE

II. Dates (important events)

Enumeration Date: 05/21/2021
Last Update Date: 04/29/2024
Certification Date: 04/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2724 5TH ST W STE A
LEHIGH ACRES FL
33971-1581
US

IV. Provider business mailing address

363 PEMBROKE ST, LEHIGH ACRES, FL.
LEHIGH ACRES FL
33974-9571
US

V. Phone/Fax

Practice location:
  • Phone: 239-303-1501
  • Fax: 888-803-9101
Mailing address:
  • Phone: 239-297-8654
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT37150
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: