Provider Demographics
NPI:1972930238
Name:CHUPKA-FUSON, MEGAN A (DPT)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:A
Last Name:CHUPKA-FUSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:A
Other - Last Name:CHUPKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1650 BARLOW ST
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49686-4721
Mailing Address - Country:US
Mailing Address - Phone:231-941-3100
Mailing Address - Fax:231-922-0382
Practice Address - Street 1:128 AMES ST
Practice Address - Street 2:
Practice Address - City:ELK RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49629-9739
Practice Address - Country:US
Practice Address - Phone:231-264-6682
Practice Address - Fax:231-264-9188
Is Sole Proprietor?:No
Enumeration Date:2013-10-02
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501016486225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist