Provider Demographics
NPI:1871667428
Name:KRUPKE, NICOLE (MPT)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:KRUPKE
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23525 SR 231 N
Mailing Address - Street 2:
Mailing Address - City:EDWALL
Mailing Address - State:WA
Mailing Address - Zip Code:99008-0636
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8502 N NEVADA ST
Practice Address - Street 2:STE 2
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-7395
Practice Address - Country:US
Practice Address - Phone:509-487-2958
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT000087062251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8359655Medicaid