Provider Demographics
NPI:1649569633
Name:RUPLE, LARRY DOUGLAS (PT)
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:DOUGLAS
Last Name:RUPLE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3219 E 10TH ST
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64801-5622
Mailing Address - Country:US
Mailing Address - Phone:417-438-2344
Mailing Address - Fax:
Practice Address - Street 1:3219 E 10TH ST
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64801-5622
Practice Address - Country:US
Practice Address - Phone:417-438-2344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-30
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37678225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist