Provider Demographics
NPI:1891829636
Name:HUPP, DANE ESTEL (MSPT)
Entity type:Individual
Prefix:MR
First Name:DANE
Middle Name:ESTEL
Last Name:HUPP
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23245 OLD SCENIC HWY
Mailing Address - Street 2:
Mailing Address - City:ZACHARY
Mailing Address - State:LA
Mailing Address - Zip Code:70791-6200
Mailing Address - Country:US
Mailing Address - Phone:225-570-2293
Mailing Address - Fax:
Practice Address - Street 1:17050 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 203
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-3221
Practice Address - Country:US
Practice Address - Phone:225-756-3744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA03881R171W00000X, 225100000X, 225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner