Provider Demographics
NPI:1093380156
Name:KUPPER, EMILY ANN (PT, DPT)
Entity type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:ANN
Last Name:KUPPER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:MISS
Other - First Name:EMILY
Other - Middle Name:ANN
Other - Last Name:LOWE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:EMILY LOWE
Mailing Address - Street 1:363 PEMBROKE ST, LEHIGH ACRES, FL.
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33974-9571
Mailing Address - Country:US
Mailing Address - Phone:239-297-8654
Mailing Address - Fax:
Practice Address - Street 1:2724 5TH ST W STE A
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33971-1581
Practice Address - Country:US
Practice Address - Phone:239-303-1501
Practice Address - Fax:888-803-9101
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-21
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT371502251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic