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NPI Code Detail

MEDICARE: MS. RUTH ADELE BURD PT

MEDICARE: MS. RUTH ADELE BURD 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
1225100000XPhysical Therapist2561NM

General Provider Information

NPI Number : 1942466289
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. RUTH ADELE BURD PT
Provider Business Mailing Address
First Line : PO BOX 2267
Second Line :
City : SANTA FE
State : NM
Zip : 87504-2267
Country : US
Telephone Number : 505-327-7720
Fax Number : 505-325-2477
Provider Business Practice Location Address
First Line : 608 REILLY AVE
Second Line :
City : FARMINGTON
State : NM
Zip : 87401-2634
Country : US
Telephone Number : 505-327-7720
Fax Number : 505-325-2477
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/06/2008
Last Update Date : 03/17/2011

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