Provider Demographics
NPI:1235621509
Name:RUPORT, JAMES
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:RUPORT
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 1:1023 SE 48TH PL
Mailing Address - Street 2:
Mailing Address - City:TROUTDALE
Mailing Address - State:OR
Mailing Address - Zip Code:97060-4524
Mailing Address - Country:US
Mailing Address - Phone:319-210-1802
Mailing Address - Fax:
Practice Address - Street 1:1023 SE 48TH PL
Practice Address - Street 2:
Practice Address - City:TROUTDALE
Practice Address - State:OR
Practice Address - Zip Code:97060-4524
Practice Address - Country:US
Practice Address - Phone:319-210-1802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-03
Last Update Date:2018-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty