Provider Demographics
NPI:1013916337
Name:HUPP, JON (PT, MTC, CERT MDT)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:
Last Name:HUPP
Suffix:
Gender:M
Credentials:PT, MTC, CERT MDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7401 W HIGHWAY 71
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78735-8260
Mailing Address - Country:US
Mailing Address - Phone:512-288-2700
Mailing Address - Fax:512-288-2711
Practice Address - Street 1:7401 W HIGHWAY 71
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78735-8260
Practice Address - Country:US
Practice Address - Phone:512-288-2700
Practice Address - Fax:512-288-2711
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1087641225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8T0587OtherBCBS ID
TX8A6023Medicare PIN