Provider Demographics
NPI:1326383068
Name:HUPPER, CYNTHIA H (PTA)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:H
Last Name:HUPPER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3151 MILL RUN CT
Mailing Address - Street 2:
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34287-1806
Mailing Address - Country:US
Mailing Address - Phone:941-423-6759
Mailing Address - Fax:
Practice Address - Street 1:4602 NORTHGATE CT
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34234-2125
Practice Address - Country:US
Practice Address - Phone:941-355-4259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-06
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1388225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant