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General NPI Number Information
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NPI Number | 1619165784
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Entity Type | Individual
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Provider Name | RENEE' WENNELL RUPERT PTA
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Gender | Female
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Dates
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Enumeration Date | 10/14/2007
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Last Update Date | 10/14/2007
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Provider Practice Location Address
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Address Line | 31 W GROVE ST
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City | MIDDLEBORO
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State | MA
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Zip | 02346-1806
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Country | US
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Telephone | 508-947-5195
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Fax |
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Provider Business Mailing Address
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Address Line | 132 HOWLAND RD
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City | LAKEVILLE
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State | MA
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Zip | 02347-2214
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Country | US
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Telephone | 508-946-1414
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 1136
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA000517
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 000706-1
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License Number State | NY
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