Provider Demographics
NPI:1760760441
Name:KAUPPILA, BRIDGET KAY (PT)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:KAY
Last Name:KAUPPILA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:BRIDGET
Other - Middle Name:KAY
Other - Last Name:LEUKUMA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 30180
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84130-0180
Mailing Address - Country:US
Mailing Address - Phone:801-256-6399
Mailing Address - Fax:
Practice Address - Street 1:2655 W 9000 S
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-8542
Practice Address - Country:US
Practice Address - Phone:612-273-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8814225100000X
UT9801652-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist