Healthcare Provider Details

I. General information

NPI: 1073111019
Provider Name (Legal Business Name): RUTH LOOKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2020
Last Update Date: 10/13/2020
Certification Date: 10/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5790 DENLINGER RD
DAYTON OH
45426-1838
US

IV. Provider business mailing address

3737 BULLE RD
SIDNEY OH
45365-8708
US

V. Phone/Fax

Practice location:
  • Phone: 937-837-5581
  • Fax:
Mailing address:
  • Phone: 937-638-8010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number012715
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: