Healthcare Provider Details

I. General information

NPI: 1124003223
Provider Name (Legal Business Name): PHILLIP A RUFF MPT, CHT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2005
Last Update Date: 10/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 NE MOTHER JOSEPH PL SUITE 110
VANCOUVER WA
98664-3299
US

IV. Provider business mailing address

200 NE MOTHER JOSEPH PL SUITE 210
VANCOUVER WA
98664-3299
US

V. Phone/Fax

Practice location:
  • Phone: 360-254-6161
  • Fax: 360-449-1139
Mailing address:
  • Phone: 360-254-6161
  • Fax: 360-449-1139

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251H1200X
TaxonomyHand Physical Therapist
License Number3039
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code2251H1200X
TaxonomyHand Physical Therapist
License NumberPT00007743
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: