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General NPI Number Information
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NPI Number | 1770138331
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Entity Type | Individual
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Provider Name | KODY KRUPPS
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Gender | Male
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Dates
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Enumeration Date | 08/09/2019
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Last Update Date | 08/09/2019
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Provider Practice Location Address
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Address Line | 2751 O'VARSITY WAY
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City | CINCINNATI
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State | OH
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Zip | 45221-0001
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Country | US
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Telephone | 513-556-3178
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Fax |
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Provider Business Mailing Address
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Address Line | 131 WELLINGTON PL UNIT B106
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City | CINCINNATI
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State | OH
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Zip | 45219-2681
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Country | US
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Telephone | 309-712-1668
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251S0007X
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Taxonomy Name | Sports Physical Therapist
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License Number | PT018159
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT018159
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License Number State | OH
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