Provider Demographics
NPI:1851511547
Name:RUPP, PAULA J (PT)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:J
Last Name:RUPP
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 HAWTHORNE CIR
Mailing Address - Street 2:
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-8230
Mailing Address - Country:US
Mailing Address - Phone:802-338-1696
Mailing Address - Fax:
Practice Address - Street 1:1110 PRIM RD
Practice Address - Street 2:
Practice Address - City:COLCHESTER
Practice Address - State:VT
Practice Address - Zip Code:05446-6403
Practice Address - Country:US
Practice Address - Phone:802-658-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT040-0003353225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist