MEDICARE: KYLIE NICOLE RUPERT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	9128	TN

General Provider Information

NPI Number	:	1346196094
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYLIE NICOLE RUPERT

Provider Business Mailing Address
First Line	:	400 S HALL ST APT 426
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75226-1947
Country	:	US
Telephone Number	:	817-908-7043
Fax Number	:

Provider Business Practice Location Address
First Line	:	1023 N BELT LINE RD
Second Line	:
City	:	MESQUITE
State	:	TX
Zip	:	75149-1788
Country	:	US
Telephone Number	:	972-216-2400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/05/2026
Last Update Date	:	03/05/2026

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Directions to “ KYLIE NICOLE RUPERT ” Practice Location

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