MEDICARE: DR. REBECCA RUTLEDGE PH.D.

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	103TF0200X	Forensic Psychologist	P1809	TN

General Provider Information

NPI Number	:	1578513909
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. REBECCA RUTLEDGE PH.D.

Provider Business Mailing Address
First Line	:	5100 POPLAR AVE
Second Line	:	SUITE 2223
City	:	MEMPHIS
State	:	TN
Zip	:	38137-4000
Country	:	US
Telephone Number	:	901-766-9066
Fax Number	:

Provider Business Practice Location Address
First Line	:	5100 POPLAR AVE
Second Line	:	SUITE 2223
City	:	MEMPHIS
State	:	TN
Zip	:	38137-4000
Country	:	US
Telephone Number	:	901-766-9066
Fax Number	:

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

Provider Enumeration Date	:	05/10/2006
Last Update Date	:	08/28/2007

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