=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699360156
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GINGER RUHMANN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/06/2021
-----------------------------------------------------
Last Update Date | 03/06/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13314 MANCHESTER RD
-----------------------------------------------------
City | DES PERES
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63131-1709
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-775-0183
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4102 HH RD
-----------------------------------------------------
City | WATERLOO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62298-2248
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 618-972-3480
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225200000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Assistant
-----------------------------------------------------
License Number | 2019009342
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------