Provider Demographics
NPI:1114903044
Name:SCHUPPE, VICTORIA ANN (PT)
Entity Type:Individual
Prefix:MS
First Name:VICTORIA
Middle Name:ANN
Last Name:SCHUPPE
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 1:2000 SHELLEY PL
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-5137
Mailing Address - Country:US
Mailing Address - Phone:516-505-2683
Mailing Address - Fax:
Practice Address - Street 1:136 GLENWOOD RD.
Practice Address - Street 2:
Practice Address - City:GLENWOOD LANDING
Practice Address - State:NY
Practice Address - Zip Code:11547-0274
Practice Address - Country:US
Practice Address - Phone:516-676-1445
Practice Address - Fax:516-676-1449
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY12323225100000X, 2251H1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Not Answered2251H1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ25821Medicare ID - Type UnspecifiedPHYSICAL THERAPIST