| Doctor Name: | DR. JESSICA DE MARIE LUPO |
| NPI Number: | 1568479350 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | D.C. |
| License Number: | 2301008650 |
| Business Practice Address: | 27850 Gratiot Ave Roseville, MI - 480664803 |
| Business Phone Number: | 5867725876 |
| Business Fax Number: | 5867721122 |
| Mailing Address: | 27850 Gratiot Ave, ROSEVILLE |
| State: | MI |
| Postal Code: | 480664803 |
| Phone Number: | 5867725876 |
| Fax Number: | 5867721122 |
| NPI Enumeration Date: | 08/02/2006 |
| NPI Last Update Date: | 06/08/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 2301008650 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MI |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |