Provider Demographics
NPI:1154404671
Name:KUPISZEWSKI, CAROLE SUZANNE J (PT, IMT, C)
Entity type:Individual
Prefix:
First Name:CAROLE SUZANNE
Middle Name:J
Last Name:KUPISZEWSKI
Suffix:
Gender:F
Credentials:PT, IMT, C
Other - Prefix:
Other - First Name:C. SUZANNE
Other - Middle Name:JOSEPH
Other - Last Name:KUPISZEWSKI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT, IMTC
Mailing Address - Street 1:300 E 5TH AVE
Mailing Address - Street 2:STE. 235
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-3177
Mailing Address - Country:US
Mailing Address - Phone:630-219-0091
Mailing Address - Fax:630-219-0029
Practice Address - Street 1:300 E 5TH AVE
Practice Address - Street 2:STE. 235
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-3177
Practice Address - Country:US
Practice Address - Phone:630-219-0091
Practice Address - Fax:630-219-0029
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-21
Last Update Date:2014-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070001948225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY137MOtherBLUE CROSS BLUE SHIELD OF FLORIDA