Healthcare Provider Details

I. General information

NPI: 1285081505
Provider Name (Legal Business Name): RUTH CAMERON PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2016
Last Update Date: 07/02/2020
Certification Date: 07/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 ST PATRICK PL
PORT HENRY NY
12974-1200
US

IV. Provider business mailing address

114 WILBUR LN
SPECULATOR NY
12164-7707
US

V. Phone/Fax

Practice location:
  • Phone: 518-546-7151
  • Fax:
Mailing address:
  • Phone: 518-546-7151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number030731
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: