Provider Demographics
NPI:1700939261
Name:SHUPING, NICOLE S (PT)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:S
Last Name:SHUPING
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7522 KENNEBEC DR
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27517-8598
Mailing Address - Country:US
Mailing Address - Phone:919-968-3456
Mailing Address - Fax:919-932-3456
Practice Address - Street 1:1829 E FRANKLIN ST
Practice Address - Street 2:BLDG. # 600
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-5861
Practice Address - Country:US
Practice Address - Phone:919-968-3456
Practice Address - Fax:919-932-3456
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10449225100000X, 2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Not Answered2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC067WMOtherBLUE CROSS
NC7212075Medicaid