=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427079326
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHARON JEANINE RUHSAM P.T.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/23/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4225 GOLDEN VALLEY RD
-----------------------------------------------------
City | GOLDEN VALLEY
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55422-4215
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 763-302-4102
-----------------------------------------------------
Fax | 763-287-2309
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4225 GOLDEN VALLEY RD
-----------------------------------------------------
City | GOLDEN VALLEY
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55422-4215
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 763-302-4102
-----------------------------------------------------
Fax | 763-287-2309
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 970
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------