Provider Demographics
NPI:1700010444
Name:RUPPELT, PATRICIA KAY (MPT)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:KAY
Last Name:RUPPELT
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 1:538 PACIFIC AVE
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-2125
Mailing Address - Country:US
Mailing Address - Phone:510-523-5456
Mailing Address - Fax:
Practice Address - Street 1:538 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-2125
Practice Address - Country:US
Practice Address - Phone:510-523-5456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-10
Last Update Date:2009-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18778225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist