MEDICARE: JON HUPP PT, MTC, CERT. MDT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	1087641	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8T0587	OTHER	TX	BCBS ID

General Provider Information

NPI Number	:	1013916337
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JON HUPP PT, MTC, CERT. MDT

Provider Business Mailing Address
First Line	:	7401 W HIGHWAY 71
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78735-8260
Country	:	US
Telephone Number	:	512-288-2700
Fax Number	:	512-288-2711

Provider Business Practice Location Address
First Line	:	7401 W HIGHWAY 71
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78735-8260
Country	:	US
Telephone Number	:	512-288-2700
Fax Number	:	512-288-2711

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	11/20/2007

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