Healthcare Provider Details

I. General information

NPI: 1528618956
Provider Name (Legal Business Name): ANDREW JOHN KUPNIEWSKI MS, LAT, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2019
Last Update Date: 09/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 E 8TH ST
ERIE PA
16503-1003
US

IV. Provider business mailing address

626 ALGERIA RD
ERIE PA
16505-4004
US

V. Phone/Fax

Practice location:
  • Phone: 814-480-6106
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: