Provider Demographics
NPI:1063157196
Name:COUPAL, LUCIA MICAELA (LMT)
Entity type:Individual
Prefix:
First Name:LUCIA
Middle Name:MICAELA
Last Name:COUPAL
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 S EUCLID AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-4916
Mailing Address - Country:US
Mailing Address - Phone:208-502-0728
Mailing Address - Fax:
Practice Address - Street 1:102 S EUCLID AVE STE 201
Practice Address - Street 2:
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-4916
Practice Address - Country:US
Practice Address - Phone:208-502-0728
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-03
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDMAS-2494225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDMAS-2494OtherLICENSE