Provider Demographics
NPI:1710541628
Name:PUPO, PATSY LI (MT)
Entity Type:Individual
Prefix:
First Name:PATSY
Middle Name:LI
Last Name:PUPO
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:PATSY
Other - Middle Name:LI
Other - Last Name:VIOLANTE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:16150 KIETH HARROW BLVD APT 3201
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77084-5468
Mailing Address - Country:US
Mailing Address - Phone:281-661-0071
Mailing Address - Fax:
Practice Address - Street 1:6989 W LITTLE YORK RD STE 25B
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77040-4843
Practice Address - Country:US
Practice Address - Phone:281-661-0071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-25
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11506225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist