Active NPI
Bryan Rupke
- Physical Therapist
- Costa Mesa, CA
National Provider Identifier
1447925474
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT300236
- Practice address
- 2755 Bristol St Ste 130
Costa Mesa, CA 92626-5985 - Phone
- (714) 966-2950
- Fax
- (714) 557-2487
- NPI assigned
- Aug 11, 2021
- Sex
- Male
- 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 | PT300236 | CA | Primary |
Addresses
Primary practice location
2755 Bristol St Ste 130
Costa Mesa, CA 92626-5985
Mailing address
2755 Bristol St Ste 130
Costa Mesa, CA 92626-5985
Phone (714) 966-2950
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 |
|---|---|---|---|
| PT300236 | CA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1628640000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1628640000000",
"number": "1447925474",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2755 BRISTOL ST STE 130",
"city": "COSTA MESA",
"state": "CA",
"postal_code": "926265985",
"telephone_number": "714-966-2950"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2755 BRISTOL ST STE 130",
"city": "COSTA MESA",
"state": "CA",
"postal_code": "926265985",
"telephone_number": "714-966-2950",
"fax_number": "714-557-2487"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUPKE",
"first_name": "BRYAN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-08-11",
"last_updated": "2021-08-11",
"certification_date": "2021-08-11",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "PT300236",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Costa Mesa, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.