Provider Demographics
NPI:1982121273
Name:KUPCHIK, KRISTEN (DPT)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:
Last Name:KUPCHIK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8836 TYLER BLVD
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-4361
Mailing Address - Country:US
Mailing Address - Phone:440-255-9553
Mailing Address - Fax:440-255-9563
Practice Address - Street 1:8836 TYLER BLVD
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-4361
Practice Address - Country:US
Practice Address - Phone:440-255-9553
Practice Address - Fax:440-255-9563
Is Sole Proprietor?:No
Enumeration Date:2017-08-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT017104208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation