Healthcare Provider Details

I. General information

NPI: 1114065786
Provider Name (Legal Business Name): MARY MARGARET RUPARD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1024 COVE WOOD DR
JONESVILLE NC
28642-9199
US

IV. Provider business mailing address

1024 COVE WOOD DR
JONESVILLE NC
28642-9199
US

V. Phone/Fax

Practice location:
  • Phone: 919-360-5282
  • Fax: 919-932-7215
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberP10832
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: