Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 070016293 | IL |
NPI | 1003088188 |
---|---|
Provider Name | Brandi N. Ruzich |
First Address | Pittsfield, IL 62363 |
Second Address | Pittsfield, IL 62363 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2008 |
Last Update Date | 26/08/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
070016293 | ILLINOIS LICENSE NUMBER (01) |