Provider Demographics
NPI:1649081563
Name:RAPPAPORT, JAKE (PT, DPT, COMT)
Entity type:Individual
Prefix:DR
First Name:JAKE
Middle Name:
Last Name:RAPPAPORT
Suffix:
Gender:M
Credentials:PT, DPT, COMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1906 BEDFORD ST APT 1
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-4765
Mailing Address - Country:US
Mailing Address - Phone:917-557-8407
Mailing Address - Fax:
Practice Address - Street 1:75 HOLLY HILL LN FL 2
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830-2917
Practice Address - Country:US
Practice Address - Phone:203-276-8526
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-20
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT14459225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist