Provider Demographics
NPI:1306222575
Name:KUPIEC, KEITH (DPT, ATC, CSCS)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:
Last Name:KUPIEC
Suffix:
Gender:M
Credentials:DPT, ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 RIVERSIDE ST
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03062-1396
Mailing Address - Country:US
Mailing Address - Phone:603-881-9990
Mailing Address - Fax:
Practice Address - Street 1:29 RIVERSIDE ST
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03062-1396
Practice Address - Country:US
Practice Address - Phone:603-881-9990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-10
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH4011225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist