Provider Demographics
NPI:1588283733
Name:POKUPEC, KATHLEEN G (PT)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:G
Last Name:POKUPEC
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8458 HIGHRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-6506
Mailing Address - Country:US
Mailing Address - Phone:513-302-2185
Mailing Address - Fax:
Practice Address - Street 1:8458 HIGHRIDGE DR
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-6506
Practice Address - Country:US
Practice Address - Phone:513-302-2185
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-08
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT-8061225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist