Provider Demographics
NPI:1770715401
Name:RUPP, KEVIN J (DPT)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:J
Last Name:RUPP
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1610 GROVER ST
Mailing Address - Street 2:STE B2
Mailing Address - City:LYNDEN
Mailing Address - State:WA
Mailing Address - Zip Code:98264
Mailing Address - Country:US
Mailing Address - Phone:360-354-5245
Mailing Address - Fax:360-354-7796
Practice Address - Street 1:1610 GROVER ST
Practice Address - Street 2:STE B2
Practice Address - City:LYNDEN
Practice Address - State:WA
Practice Address - Zip Code:98264-1539
Practice Address - Country:US
Practice Address - Phone:360-354-5245
Practice Address - Fax:360-354-7796
Is Sole Proprietor?:No
Enumeration Date:2009-08-13
Last Update Date:2009-08-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAPT600934522251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic