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General NPI Number Information
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NPI Number | 1194157925
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Entity Type | Individual
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Provider Name | CASSANDRA DEE RUTLEDGE PTA
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Gender | Female
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Dates
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Enumeration Date | 08/03/2013
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Last Update Date | 08/03/2013
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Provider Practice Location Address
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Address Line | 7105 MISSION RD
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City | PRAIRIE VILLAGE
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State | KS
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Zip | 66208-3077
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Country | US
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Telephone | 913-766-6333
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Fax | 913-766-3519
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Provider Business Mailing Address
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Address Line | 1113 S 11TH ST
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City | LOUISBURG
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State | KS
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Zip | 66053-8407
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Country | US
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Telephone | 913-212-8222
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 14-02034
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License Number State | KS
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