Provider Demographics
NPI:1073044095
Name:BHUPATHI, SWAPNA
Entity Type:Individual
Prefix:
First Name:SWAPNA
Middle Name:
Last Name:BHUPATHI
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 1:725 WYE OAK DR
Mailing Address - Street 2:
Mailing Address - City:FRUITLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21826-1929
Mailing Address - Country:US
Mailing Address - Phone:410-603-4848
Mailing Address - Fax:
Practice Address - Street 1:ATLANTIC SHORE REHAB AND HEALTH CENTER
Practice Address - Street 2:231 S WASHINGTON STREET
Practice Address - City:MILLSBORO
Practice Address - State:DE
Practice Address - Zip Code:19966
Practice Address - Country:US
Practice Address - Phone:302-934-7300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-22
Last Update Date:2018-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ1-0003544225100000X
MD26299225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist