Healthcare Provider Details

I. General information

NPI: 1861725517
Provider Name (Legal Business Name): MARY RUTH PERSSON PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2009
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 W 94TH PL
CROWN POINT IN
46307-1710
US

IV. Provider business mailing address

60 W 94TH PL
CROWN POINT IN
46307-1710
US

V. Phone/Fax

Practice location:
  • Phone: 219-926-5850
  • Fax:
Mailing address:
  • Phone: 219-926-5850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number3179
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number061874T
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP055256T
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: