Individual
MICHAELA BROOKE LUPO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
2519 COVE AVE, LA GRANDE, OR 97850-3910
(541) 962-0830
(541) 975-2720
Mailing address
2515 N 2ND ST, LA GRANDE, OR 97850-2319
(816) 977-3870
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
11-06290
KS
225100000X
Physical Therapist
2019021794
MO
225100000X
Physical Therapist
Primary
63427
OR
Other
Enumeration date
08/23/2019
Last updated
08/23/2019
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