MEDICARE: MR. KARL JOSEF RUPRECHT PT

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	2251G0304X	Geriatric Physical Therapist	PT-1531	ID

General Provider Information

NPI Number	:	1427392828
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KARL JOSEF RUPRECHT PT

Provider Business Mailing Address
First Line	:	649 LYNWOOD BLVD
Second Line	:
City	:	TWIN FALLS
State	:	ID
Zip	:	83301-4134
Country	:	US
Telephone Number	:	208-736-8648
Fax Number	:

Provider Business Practice Location Address
First Line	:	649 LYNWOOD BLVD
Second Line	:
City	:	TWIN FALLS
State	:	ID
Zip	:	83301-4134
Country	:	US
Telephone Number	:	208-736-8648
Fax Number	:

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

Provider Enumeration Date	:	11/26/2012
Last Update Date	:	11/26/2012

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