Individual
JET NIALLE RUPAR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
X
Credential
LMT, CMLDT, EP-C
Contact information
Practice address
7500 BROOKTREE RD STE 117, WEXFORD, PA 15090-9285
(724) 591-8228
Mailing address
7500 BROOKTREE RD STE 117, WEXFORD, PA 15090-9285
(724) 513-5853
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MSG010937
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14230140
CAQH
—
Enumeration date
03/31/2018
Last updated
06/11/2024
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