Provider Demographics
NPI:1336279041
Name:CHUPUICO, MARIA SHEILA
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:SHEILA
Last Name:CHUPUICO
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:MARIA
Other - Middle Name:NALAM
Other - Last Name:CHUPUICO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHYSICAL THERAPIST
Mailing Address - Street 1:920 CAIRO RD
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31792
Mailing Address - Country:US
Mailing Address - Phone:229-336-8255
Mailing Address - Fax:
Practice Address - Street 1:251 US HWY 19 N
Practice Address - Street 2:
Practice Address - City:CAMILLA
Practice Address - State:GA
Practice Address - Zip Code:31730
Practice Address - Country:US
Practice Address - Phone:229-336-8255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT004636225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist