Provider Demographics
NPI:1770925232
Name:RUPERT, BRIAN C (PTA)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:C
Last Name:RUPERT
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3401 S LAFAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80113-2926
Mailing Address - Country:US
Mailing Address - Phone:303-761-0075
Mailing Address - Fax:303-761-2967
Practice Address - Street 1:3401 S LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-2926
Practice Address - Country:US
Practice Address - Phone:303-761-0075
Practice Address - Fax:303-761-2967
Is Sole Proprietor?:No
Enumeration Date:2013-07-25
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTA.0012853174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist