Provider Demographics
NPI:1538505664
Name:HUPP, LAUREN ANN (DPT)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:ANN
Last Name:HUPP
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5129 HAWTHORNE DR
Mailing Address - Street 2:APARTMENT B
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50265-6952
Mailing Address - Country:US
Mailing Address - Phone:515-975-9109
Mailing Address - Fax:
Practice Address - Street 1:4911 SW 19TH ST
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50315-4487
Practice Address - Country:US
Practice Address - Phone:515-285-2559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-15
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA004972225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist