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General NPI Number Information
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NPI Number | 1518032036
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Entity Type | Individual
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Provider Name | JACKIE RUTLEDGE CMT
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Gender | Female
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Dates
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Enumeration Date | 11/21/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 200 DELAWARE ST
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City | HONESDALE
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State | PA
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Zip | 18431-1150
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Country | US
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Telephone | 570-253-9039
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Fax | 570-253-9052
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Provider Business Mailing Address
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Address Line | 1072 OWEGO TPKE
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City | HONESDALE
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State | PA
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Zip | 18431-2308
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Country | US
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Telephone | 570-253-9039
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Fax | 570-253-9052
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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