Provider Demographics
NPI:1104964691
Name:CULPEPPER, KRISTIE H (PT DPT MTC)
Entity type:Individual
Prefix:MRS
First Name:KRISTIE
Middle Name:H
Last Name:CULPEPPER
Suffix:
Gender:F
Credentials:PT DPT MTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6723 JEFFERSON HWY
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-8106
Mailing Address - Country:US
Mailing Address - Phone:225-926-2400
Mailing Address - Fax:225-926-2470
Practice Address - Street 1:6723 JEFFERSON HWY
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-8106
Practice Address - Country:US
Practice Address - Phone:225-926-2400
Practice Address - Fax:225-926-2470
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA04515225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAG5372OtherBLUE CROSS BLUE SHIELD
LA204969100OtherDEPT OF LABOR
G5372Medicare UPIN