Provider Demographics
NPI:1942936588
Name:KUIPERS, PAUL (DPT, CLT-LANA)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:KUIPERS
Suffix:
Gender:M
Credentials:DPT, CLT-LANA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 BURGESS LN
Mailing Address - Street 2:
Mailing Address - City:GREENBRIER
Mailing Address - State:AR
Mailing Address - Zip Code:72058-9641
Mailing Address - Country:US
Mailing Address - Phone:501-402-0787
Mailing Address - Fax:
Practice Address - Street 1:58 BURGESS LN
Practice Address - Street 2:
Practice Address - City:GREENBRIER
Practice Address - State:AR
Practice Address - Zip Code:72058-9641
Practice Address - Country:US
Practice Address - Phone:501-402-0787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-26
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3398225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist