Provider Demographics
NPI:1932109626
Name:TUPPER, DAVID LLOYD (PT)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:LLOYD
Last Name:TUPPER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1711 DALLES MILITARY RD
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362
Mailing Address - Country:US
Mailing Address - Phone:509-529-3220
Mailing Address - Fax:888-828-3016
Practice Address - Street 1:1711 DALLES MILITARY RD
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-8028
Practice Address - Country:US
Practice Address - Phone:509-529-3220
Practice Address - Fax:888-828-3016
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-26
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00003096225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7060916Medicaid
WA115000238Medicare ID - Type Unspecified