Healthcare Provider Details

I. General information

NPI: 1467578302
Provider Name (Legal Business Name): SUZANNE RUTH PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 WESTFIELD RD
NOBLESVILLE IN
46060-1323
US

IV. Provider business mailing address

601 WESTFIELD RD
NOBLESVILLE IN
46060-1323
US

V. Phone/Fax

Practice location:
  • Phone: 317-776-7225
  • Fax: 317-776-7226
Mailing address:
  • Phone: 317-776-7225
  • Fax: 317-776-7226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: