Active NPI
Lynn Marie Rupp, PT
- Physical Therapist
- Erie, PA
National Provider Identifier
1083613863
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT008173L
- Practice address
- 5100 Peach St
Erie, PA 16509-2482 - Phone
- (814) 864-5097
- Fax
- (814) 864-9583
- NPI assigned
- Jul 14, 2005
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT008173L | PA | Primary |
Addresses
Primary practice location
5100 Peach St
Erie, PA 16509-2482
Mailing address
717 State St
Suite 16, LL
Erie, PA 16501-1341
Phone (814) 480-7100
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P00170285 | Other | PA | RR MEDICARE |
| 1008723830007 | Medicaid | PA | |
| 001607036 | Other | PA | BLUE SHIELD |
| 146211 | Other | PA | UNISON |
| 251403958 | Other | PA | UPMC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT008173L | PA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1121299200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1210550400000",
"number": "1083613863",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "717 STATE ST",
"address_2": "SUITE 16, LL",
"city": "ERIE",
"state": "PA",
"postal_code": "165011341",
"telephone_number": "814-480-7100",
"fax_number": "814-480-7604"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5100 PEACH ST",
"city": "ERIE",
"state": "PA",
"postal_code": "165092482",
"telephone_number": "814-864-5097",
"fax_number": "814-864-9583"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUPP",
"first_name": "LYNN",
"middle_name": "MARIE",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-07-14",
"last_updated": "2008-05-12",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "PA",
"license": "PT008173L",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE",
"identifier": "P00170285",
"state": "PA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1008723830007",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD",
"identifier": "001607036",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNISON",
"identifier": "146211",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UPMC",
"identifier": "251403958",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Erie, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.