Healthcare Provider Details

I. General information

NPI: 1689589848
Provider Name (Legal Business Name): JUSTIN HUPP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 SOUTHWIND PLAZA DR #1250
MOUNT VERNON IN
47620-2209
US

IV. Provider business mailing address

1650 LYNDON FARM CT STE 300
LOUISVILLE KY
40223-5005
US

V. Phone/Fax

Practice location:
  • Phone: 812-643-1170
  • Fax: 812-643-1171
Mailing address:
  • Phone: 726-202-3039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05016564A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: