Ronald Rutten
Individual provider Active NPI Physical Therapist · Soda Springs, ID
NPI 1184097271 · NPPES record last updated Nov 11, 2015
Key facts
- NPI
- 1184097271
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- PT-433 (ID)
- Practice address
- 300 S 3Rd W
Soda Springs, ID 83276-1559 - Phone
- (208) 547-3341
- Fax
- (208) 547-2790
- NPI assigned
- Nov 11, 2015
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT-433 | ID | MD | Physical Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT-433 | ID | Yes |
Addresses
Primary practice location
300 S 3Rd W
Soda Springs, ID 83276-1559
Mailing address
1872 N Honeysuckle LN
Inkom, ID 83245-1612
Phone (208) 775-3531
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PT-433 | Other | ID | BUREAU OF OCCUPATIONAL LICENSES |
Other providers in Soda Springs, ID
- Oregon Trail Eye Care, PC
- PHG Inc.
- PT Works Inc
- Craig Harden Richardson
- RMC Management, LLC
- Terry H. Sanderson
- Saxton Medical Supply LLC
- Jared Mark Shelton
- Brett A Smith
- Kevin Courtney Smith
All providers in Soda Springs, ID · Physical Therapist in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 11, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.