Provider Demographics
NPI:1780965210
Name:GUPTA, ANUPAMA
Entity type:Individual
Prefix:
First Name:ANUPAMA
Middle Name:
Last Name:GUPTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26105 REGENCY CLUB LN
Mailing Address - Street 2:APT #8
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48089-6271
Mailing Address - Country:US
Mailing Address - Phone:586-219-1571
Mailing Address - Fax:
Practice Address - Street 1:26105 REGENCY CLUB LN
Practice Address - Street 2:APT #8
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48089-6271
Practice Address - Country:US
Practice Address - Phone:586-219-1571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-29
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist