Provider Demographics
NPI:1750385548
Name:DUPUIS, CYNTHIA J (PT)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:J
Last Name:DUPUIS
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:PO BOX 851
Mailing Address - Street 2:
Mailing Address - City:SAINT CROIX FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54024-0851
Mailing Address - Country:US
Mailing Address - Phone:715-483-9221
Mailing Address - Fax:715-483-7143
Practice Address - Street 1:210 W BUTTERNUT AVE
Practice Address - Street 2:
Practice Address - City:LUCK
Practice Address - State:WI
Practice Address - Zip Code:54853-9301
Practice Address - Country:US
Practice Address - Phone:715-472-8120
Practice Address - Fax:715-472-4047
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4774024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40407600Medicaid
WI40407600Medicaid