Healthcare Provider Details

I. General information

NPI: 1265149843
Provider Name (Legal Business Name): ALLISON HAILEY RUTHE PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2022
Last Update Date: 10/02/2023
Certification Date: 09/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 W 94TH ST
BLOOMINGTON MN
55420-4206
US

IV. Provider business mailing address

7300 BRISTOL VILLAGE DR APT 213
BLOOMINGTON MN
55438-2589
US

V. Phone/Fax

Practice location:
  • Phone: 952-885-0418
  • Fax:
Mailing address:
  • Phone: 217-741-2249
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number12890
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number12890
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: