Healthcare Provider Details

I. General information

NPI: 1417275306
Provider Name (Legal Business Name): JASON CHRIS KUIPER PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2010
Last Update Date: 05/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1402 BOCA TEEKA DR
VALPARAISO IN
46383-4489
US

IV. Provider business mailing address

1402 BOCA TEEKA DR
VALPARAISO IN
46383-4489
US

V. Phone/Fax

Practice location:
  • Phone: 219-462-1621
  • Fax:
Mailing address:
  • Phone: 219-462-1621
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number06002289A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: