=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093380156
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EMILY ANN KUPPER PT, DPT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/21/2021
-----------------------------------------------------
Last Update Date | 04/29/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2724 5TH ST W STE A
-----------------------------------------------------
City | LEHIGH ACRES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33971-1581
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-303-1501
-----------------------------------------------------
Fax | 888-803-9101
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 363 PEMBROKE ST, LEHIGH ACRES, FL.
-----------------------------------------------------
City | LEHIGH ACRES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33974-9571
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-297-8654
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2251X0800X
-----------------------------------------------------
Taxonomy Name | Orthopedic Physical Therapist
-----------------------------------------------------
License Number | PT37150
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------