MEDICARE: MRS. LISA RUTTENBERG BOR 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	174400000X	Specialist	PTH1468	AL

General Provider Information

NPI Number	:	1851394563
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LISA RUTTENBERG BOR PT

Provider Business Mailing Address
First Line	:	2823 GREYSTONE COMM BLVD
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35242-2660
Country	:	US
Telephone Number	:	205-745-3660
Fax Number	:	205-745-3649

Provider Business Practice Location Address
First Line	:	2823 GREYSTONE COMM BLVD
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35242
Country	:	US
Telephone Number	:	205-745-3660
Fax Number	:	205-745-3649

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

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	11/09/2018

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