Provider Demographics
NPI:1477522522
Name:RUPERT, ELIZABETH A (MPT)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:RUPERT
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 713600
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84171-3600
Mailing Address - Country:US
Mailing Address - Phone:866-661-0984
Mailing Address - Fax:866-588-1518
Practice Address - Street 1:6440 SOUTH MILLROCK DRIVE
Practice Address - Street 2:SUITE 175
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84121
Practice Address - Country:US
Practice Address - Phone:866-661-0984
Practice Address - Fax:866-588-1518
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2007-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT017361225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist