Individual
MR. BRAD RUPNOW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
6515-024
WI
225100000X
Physical Therapist
PT007819
GA
2251X0800X
Orthopedic Physical Therapist
6515-024
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40349800
—
WI
05
—
934983415A
—
GA
Enumeration date
04/27/2006
Last updated
12/30/2014
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