MEDICARE: FAITH VIRGINIA ROSE KUIPERS PT, DPT

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	65569	OR

General Provider Information

NPI Number	:	1396554721
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FAITH VIRGINIA ROSE KUIPERS PT, DPT

Provider Business Mailing Address
First Line	:	1342 NE MEDICAL CENTER DR STE 150
Second Line	:
City	:	BEND
State	:	OR
Zip	:	97701-5919
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1342 NE MEDICAL CENTER DR STE 150
Second Line	:
City	:	BEND
State	:	OR
Zip	:	97701-5919
Country	:	US
Telephone Number	:	541-382-7875
Fax Number	:

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

Provider Enumeration Date	:	12/31/2024
Last Update Date	:	12/31/2024

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Directions to “ FAITH VIRGINIA ROSE KUIPERS PT, DPT” Practice Location

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