Provider Demographics
NPI:1306152640
Name:RUPPERT, MARSHA
Entity type:Individual
Prefix:
First Name:MARSHA
Middle Name:
Last Name:RUPPERT
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 1:115 GRAND BEACH PL
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-2497
Mailing Address - Country:US
Mailing Address - Phone:904-625-2597
Mailing Address - Fax:
Practice Address - Street 1:1640 GULF TO BAY BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33755-6423
Practice Address - Country:US
Practice Address - Phone:727-442-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-24
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL25600225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist