Provider Demographics
NPI:1932470952
Name:CHUPPA, KATHLEEN ANN (CMT)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:ANN
Last Name:CHUPPA
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16510 TRANQUILITY CT SE
Mailing Address - Street 2:#206
Mailing Address - City:PRIOR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55372-4452
Mailing Address - Country:US
Mailing Address - Phone:952-440-3507
Mailing Address - Fax:
Practice Address - Street 1:16510 TRANQUILITY CT SE
Practice Address - Street 2:#206
Practice Address - City:PRIOR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55372-4452
Practice Address - Country:US
Practice Address - Phone:952-440-3507
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-23
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist