Provider Demographics
NPI:1689438343
Name:LUPO, KATIE (DPT)
Entity Type:Individual
Prefix:DR
First Name:KATIE
Middle Name:
Last Name:LUPO
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 1:6136 LOVENTREE RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-3913
Mailing Address - Country:US
Mailing Address - Phone:952-484-2567
Mailing Address - Fax:
Practice Address - Street 1:6300 WOODSIDE CT STE E
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-3360
Practice Address - Country:US
Practice Address - Phone:410-312-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-12
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD29827225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist