Provider Demographics
NPI:1659755437
Name:TUPPER, SCOTT (LMP)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:TUPPER
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21715 103RD AVENUE CT E
Mailing Address - Street 2:D-401
Mailing Address - City:GRAHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98338-8152
Mailing Address - Country:US
Mailing Address - Phone:253-875-7270
Mailing Address - Fax:253-875-7269
Practice Address - Street 1:21715 103RD AVENUE CT E
Practice Address - Street 2:D-401
Practice Address - City:GRAHAM
Practice Address - State:WA
Practice Address - Zip Code:98338-8152
Practice Address - Country:US
Practice Address - Phone:253-875-7270
Practice Address - Fax:253-875-7269
Is Sole Proprietor?:No
Enumeration Date:2015-07-12
Last Update Date:2015-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60419314172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist