MEDICARE: CHRISTIAN MICHEAL RUITER LMP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	MA60188531	WA

General Provider Information

NPI Number	:	1053695510
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTIAN MICHEAL RUITER LMP

Provider Business Mailing Address
First Line	:	2014 S 8TH ST
Second Line	:
City	:	TACOMA
State	:	WA
Zip	:	98405-3030
Country	:	US
Telephone Number	:	360-980-2202
Fax Number	:

Provider Business Practice Location Address
First Line	:	6915 LAKEWOOD DR W STE A2
Second Line	:
City	:	TACOMA
State	:	WA
Zip	:	98467-3299
Country	:	US
Telephone Number	:	253-589-8843
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2011
Last Update Date	:	10/03/2011

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