Provider Demographics
NPI:1225802093
Name:KULPA, MARK
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:KULPA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2269 W 1150 N
Mailing Address - Street 2:
Mailing Address - City:PERRYSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47974-8062
Mailing Address - Country:US
Mailing Address - Phone:217-304-6919
Mailing Address - Fax:
Practice Address - Street 1:2269 W 1150 N
Practice Address - Street 2:
Practice Address - City:PERRYSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47974-8062
Practice Address - Country:US
Practice Address - Phone:217-304-6919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-13
Last Update Date:2025-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227007700225700000X
INMT20901677225700000X
IN28186947A163WM1400X
IL041337165163WM1400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM1400XNursing Service ProvidersRegistered NurseNurse Massage Therapist (NMT)
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist