Provider Demographics
NPI:1104298082
Name:CUPP, TIMOTHY KEITH (PT)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:KEITH
Last Name:CUPP
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 RICHMOND RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40502-1204
Mailing Address - Country:US
Mailing Address - Phone:859-268-5701
Mailing Address - Fax:859-268-5636
Practice Address - Street 1:1900 RICHMOND RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40502-1204
Practice Address - Country:US
Practice Address - Phone:859-268-5701
Practice Address - Fax:859-268-5636
Is Sole Proprietor?:No
Enumeration Date:2015-10-30
Last Update Date:2015-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic