Provider Demographics
NPI:1063160240
Name:KRUPA, ANNE M
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:M
Last Name:KRUPA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1375 CLEVELAND RD W APT 205
Mailing Address - Street 2:
Mailing Address - City:HURON
Mailing Address - State:OH
Mailing Address - Zip Code:44839-1499
Mailing Address - Country:US
Mailing Address - Phone:419-262-3709
Mailing Address - Fax:
Practice Address - Street 1:1717 E PERKINS AVE
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-7919
Practice Address - Country:US
Practice Address - Phone:419-262-3709
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-16
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty