Healthcare Provider Details

I. General information

NPI: 1811946502
Provider Name (Legal Business Name): RUTH S BACKWAY P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 S MCCORMICK ST
PRESCOTT AZ
86303-4714
US

IV. Provider business mailing address

250 S MCCORMICK ST
PRESCOTT AZ
86303-4714
US

V. Phone/Fax

Practice location:
  • Phone: 928-777-8050
  • Fax: 928-443-9029
Mailing address:
  • Phone: 928-777-8050
  • Fax: 928-443-9029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251E1200X
TaxonomyErgonomics Physical Therapist
License Number3189
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number3189
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number3189
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: