Provider Demographics
NPI:1396292504
Name:STROUP, DEVON NICOLE
Entity type:Individual
Prefix:
First Name:DEVON
Middle Name:NICOLE
Last Name:STROUP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:389 SWINTON CT
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:19363-1270
Mailing Address - Country:US
Mailing Address - Phone:484-889-7386
Mailing Address - Fax:
Practice Address - Street 1:700 S HIGH ST
Practice Address - Street 2:WEST CHESTER UNIVERSITY
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19383-0003
Practice Address - Country:US
Practice Address - Phone:610-436-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-06
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0073272255A2300X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer