Individual
MICHAEL RUPP
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2640 CHANNING WAY, IDAHO FALLS, ID 83404-7517
(208) 522-2248
(208) 522-2463
Mailing address
2640 CHANNING WAY, IDAHO FALLS, ID 83404-7517
(208) 522-2248
(208) 522-2463
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT-3511
ID
2251X0800X
Orthopedic Physical Therapist
PT-3511
ID
Other
Enumeration date
04/06/2014
Last updated
09/22/2014
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