Active NPI
Ruby Dorone Fenn, P.T.
- Physical Therapist
- Davenport, FL
National Provider Identifier
1275738239
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT19949
- Practice address
- 109 Lake Davenport Blvd
Davenport, FL 33897-9405 - Phone
- (863) 256-5030
- Fax
- (863) 256-5531
- NPI assigned
- Jun 19, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT19949 | FL | Primary |
Addresses
Primary practice location
109 Lake Davenport Blvd
Davenport, FL 33897-9405
Mailing address
109 Lake Davenport Blvd
Davenport, FL 33897-9405
Phone (863) 256-5030
Other names 1
- Miss Ruby C Dorone
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT19949 | FL | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bloomfield Total Health Center | Physical Therapist | Past | Accepting new patients |
| Four Corners Chiropractic Centers PA | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Chiropractor
- Clermont, FL
- NPI 1619963147
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1182211200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1365724800000",
"number": "1275738239",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "109 LAKE DAVENPORT BLVD",
"city": "DAVENPORT",
"state": "FL",
"postal_code": "338979405",
"telephone_number": "863-256-5030",
"fax_number": "869-256-5030"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "109 LAKE DAVENPORT BLVD",
"city": "DAVENPORT",
"state": "FL",
"postal_code": "338979405",
"telephone_number": "863-256-5030",
"fax_number": "863-256-5531"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FENN",
"first_name": "RUBY",
"middle_name": "DORONE",
"credential": "P.T.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-06-19",
"last_updated": "2013-04-12",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "FL",
"license": "PT19949",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "RUBY",
"last_name": "DORONE",
"middle_name": "C",
"prefix": "MISS",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Davenport, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.