Healthcare Provider Details

I. General information

NPI: 1740939305
Provider Name (Legal Business Name): RUPHIL MARIA HEPP PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2022
Last Update Date: 03/21/2022
Certification Date: 03/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17270 BEAR VALLEY RD STE 105
VICTORVILLE CA
92395-7751
US

IV. Provider business mailing address

20004 SONOMA RD
APPLE VALLEY CA
92308-6117
US

V. Phone/Fax

Practice location:
  • Phone: 760-245-8828
  • Fax:
Mailing address:
  • Phone: 760-964-0311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number38351
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: