Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | PT006313L | PA |
NPI | 1013549963 |
---|---|
Provider Name | Kathleen Chupka |
First Address | Shavertown, PA 18708-1111 |
Second Address | Kingston, PA 18704-3322 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/02/2020 |
Last Update Date | 09/02/2020 |