MEDICARE: RUTH PEDROSA

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	05008403A	IN

General Provider Information

NPI Number	:	1871759886
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUTH PEDROSA

Provider Business Mailing Address
First Line	:	3626 SAINT JOSEPH RD
Second Line	:
City	:	NEW ALBANY
State	:	IN
Zip	:	47150-9729
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3626 SAINT JOSEPH RD
Second Line	:
City	:	NEW ALBANY
State	:	IN
Zip	:	47150-9729
Country	:	US
Telephone Number	:	812-948-0670
Fax Number	:

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

Provider Enumeration Date	:	07/30/2008
Last Update Date	:	07/30/2008

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Directions to “ RUTH PEDROSA ” Practice Location

Language	Start Address	Practice Location

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