Provider Demographics
NPI:1285090704
Name:DOUP, CALEB (PTA)
Entity type:Individual
Prefix:
First Name:CALEB
Middle Name:
Last Name:DOUP
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:781 FAIRGROUNDS RD STE A
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:OH
Mailing Address - Zip Code:43050-1165
Mailing Address - Country:US
Mailing Address - Phone:740-263-7997
Mailing Address - Fax:
Practice Address - Street 1:781 FAIRGROUNDS RD STE A
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:OH
Practice Address - Zip Code:43050-1165
Practice Address - Country:US
Practice Address - Phone:740-263-7997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-13
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH017832225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist