MEDICARE: RUTH ELIZABETH HURTADO PTA

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	8904	CA

General Provider Information

NPI Number	:	1215263611
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUTH ELIZABETH HURTADO PTA

Provider Business Mailing Address
First Line	:	9003 CHURCH ST
Second Line	:
City	:	GILROY
State	:	CA
Zip	:	95020-2707
Country	:	US
Telephone Number	:	408-835-0710
Fax Number	:

Provider Business Practice Location Address
First Line	:	1893 MONTEREY RD
Second Line	:	SUITE #200
City	:	SAN JOSE
State	:	CA
Zip	:	95112-6136
Country	:	US
Telephone Number	:	408-288-3800
Fax Number	:

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

Provider Enumeration Date	:	10/20/2009
Last Update Date	:	06/17/2015

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