Provider Demographics
NPI:1487860177
Name:CUPP, MEREDITH
Entity Type:Individual
Prefix:MRS
First Name:MEREDITH
Middle Name:
Last Name:CUPP
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 1:4500 S KANSAS RD
Mailing Address - Street 2:
Mailing Address - City:SCOTT CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67871-5139
Mailing Address - Country:US
Mailing Address - Phone:620-874-1565
Mailing Address - Fax:620-275-6582
Practice Address - Street 1:4500 S KANSAS RD
Practice Address - Street 2:
Practice Address - City:SCOTT CITY
Practice Address - State:KS
Practice Address - Zip Code:67871-5139
Practice Address - Country:US
Practice Address - Phone:620-874-1565
Practice Address - Fax:620-275-6582
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1401400225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant