Provider Demographics
NPI:1215473111
Name:RAPP, ELIZABETH
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:RAPP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1326 MCARTHUR DR
Mailing Address - Street 2:
Mailing Address - City:RUSSELLTON
Mailing Address - State:PA
Mailing Address - Zip Code:15076-9734
Mailing Address - Country:US
Mailing Address - Phone:423-838-5035
Mailing Address - Fax:
Practice Address - Street 1:1326 MCARTHUR DR
Practice Address - Street 2:
Practice Address - City:RUSSELLTON
Practice Address - State:PA
Practice Address - Zip Code:15076-9734
Practice Address - Country:US
Practice Address - Phone:423-838-5035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-16
Last Update Date:2017-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE011072225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant