Provider Demographics
NPI:1578658324
Name:KIPOURAS, KATHERINE (PT)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:KIPOURAS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 BUTLER STREET
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:NH
Mailing Address - Zip Code:03079
Mailing Address - Country:US
Mailing Address - Phone:603-893-2900
Mailing Address - Fax:603-893-1628
Practice Address - Street 1:70 BUTLER STREET
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:NH
Practice Address - Zip Code:03079
Practice Address - Country:US
Practice Address - Phone:603-893-2900
Practice Address - Fax:603-893-1628
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5275225100000X
CAPT25401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY66507OtherBLUE CROSS PROVIDER ID
MA468801OtherTUFTS PROVIDER ID
MA468801OtherTUFTS PROVIDER ID