Provider Demographics
NPI:1275924649
Name:KUPIEC, JENNIFER (CMT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:KUPIEC
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:342 TAYLOR ST
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:VA
Mailing Address - Zip Code:22980-1774
Mailing Address - Country:US
Mailing Address - Phone:540-208-1727
Mailing Address - Fax:
Practice Address - Street 1:421 W MAIN ST
Practice Address - Street 2:SUITE N1
Practice Address - City:WAYNESBORO
Practice Address - State:VA
Practice Address - Zip Code:22980-4550
Practice Address - Country:US
Practice Address - Phone:540-208-1727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-06
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019012857225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist