MEDICARE: RALPH S TRUITT PT

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	225100000X	Physical Therapist	19302	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	5120	OTHER	GHMSI/BLUECHOICE
2	701076	OTHER	ACN
3	18GMMA	OTHER	BCBS OF MARYLAND

General Provider Information

NPI Number	:	1518070721
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RALPH S TRUITT PT

Provider Business Mailing Address
First Line	:	8743 PINEY ORCHARD PKWY
Second Line	:	SUITE 105
City	:	ODENTON
State	:	MD
Zip	:	21113-2343
Country	:	US
Telephone Number	:	410-598-0603
Fax Number	:

Provider Business Practice Location Address
First Line	:	8743 PINEY ORCHARD PKWY
Second Line	:	SUITE 105
City	:	ODENTON
State	:	MD
Zip	:	21113-2343
Country	:	US
Telephone Number	:	410-598-0603
Fax Number	:

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

Provider Enumeration Date	:	08/15/2006
Last Update Date	:	10/20/2009

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Directions to “ RALPH S TRUITT PT” Practice Location

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