Michaela Brooke Lupo, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

63427 Issued in OR

Practice address

2519 Cove Ave
La Grande, OR 97850-3910

Phone

(541) 962-0830

Fax

(541) 975-2720

NPI assigned

Aug 23, 2019

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1566518400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1566518400000",
    "number": "1881241834",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2515 N 2ND ST",
            "city": "LA GRANDE",
            "state": "OR",
            "postal_code": "978502319",
            "telephone_number": "816-977-3870"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2519 COVE AVE",
            "city": "LA GRANDE",
            "state": "OR",
            "postal_code": "978503910",
            "telephone_number": "541-962-0830",
            "fax_number": "541-975-2720"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LUPO",
        "first_name": "MICHAELA",
        "middle_name": "BROOKE",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-08-23",
        "last_updated": "2019-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "KS",
            "license": "11-06290",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MO",
            "license": "2019021794",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "OR",
            "license": "63427",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Erin H Long, ATC
• Nickole Diane Longend, MA
• Tera Marie Lovell, MOTR/L
• Jeremiah Douglas Lowe
• Spencer Kevin Luke, O.D.
• Rene Lyon, BSN-RN
• Tylo Mackay, LCSW
• Barbara Suzanne Madden, BA, QMHP, CADCI
• Soren Kostoff Madsen
• Andrea Marie Mallory

• Physical Therapist in La Grande, OR
• Providers in La Grande, OR by specialty
• Physical Therapist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.