Provider Demographics
NPI:1487788253
Name:LUPINSKI, ADAM ANDREW (PTA,ATC)
Entity type:Individual
Prefix:MR
First Name:ADAM
Middle Name:ANDREW
Last Name:LUPINSKI
Suffix:
Gender:M
Credentials:PTA,ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:807 SW JENNIFER TER
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-1938
Mailing Address - Country:US
Mailing Address - Phone:772-359-1827
Mailing Address - Fax:
Practice Address - Street 1:701 NW FEDERAL HWY
Practice Address - Street 2:SUITE 403
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-1005
Practice Address - Country:US
Practice Address - Phone:772-692-6928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA18513225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant