=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225802093
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARK KULPA
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/13/2023
-----------------------------------------------------
Last Update Date | 09/06/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2269 W 1150 N
-----------------------------------------------------
City | PERRYSVILLE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47974-8062
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 217-304-6919
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2269 W 1150 N
-----------------------------------------------------
City | PERRYSVILLE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47974-8062
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 217-304-6919
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | 227007700
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | MT20901677
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 163WM1400X
-----------------------------------------------------
Taxonomy Name | Nurse Massage Therapist (NMT)
-----------------------------------------------------
License Number | 28186947A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 163WM1400X
-----------------------------------------------------
Taxonomy Name | Nurse Massage Therapist (NMT)
-----------------------------------------------------
License Number | 041337165
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------