Healthcare Provider Details

I. General information

NPI: 1891829636
Provider Name (Legal Business Name): DANE ESTEL HUPP M.S.P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17050 MEDICAL CENTER DR SUITE 203
BATON ROUGE LA
70816-3221
US

IV. Provider business mailing address

23245 OLD SCENIC HWY
ZACHARY LA
70791-6200
US

V. Phone/Fax

Practice location:
  • Phone: 225-756-3744
  • Fax:
Mailing address:
  • Phone: 225-570-2293
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number03881R
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number03881R
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number03881R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: