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General NPI Number Information
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NPI Number | 1720831399
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Entity Type | Individual
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Provider Name | FAITH NICOLE RUTHERFORD
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Gender | Female
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Dates
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Enumeration Date | 04/11/2024
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Last Update Date | 04/11/2024
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Provider Practice Location Address
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Address Line | 901 S 3RD ST
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City | LOUISVILLE
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State | KY
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Zip | 40203-2215
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Country | US
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Telephone | 740-285-9166
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Fax |
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Provider Business Mailing Address
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Address Line | 37 ARBOR PL
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City | NEW ALBANY
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State | IN
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Zip | 47150-7292
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Country | US
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Telephone |
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State | KY
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