Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | PS-009007-L | PA |
NPI | 1104178680 |
---|---|
Provider Name | Dr. Philip A Rutter |
First Address | Pitman, NJ 08071-1608 |
Second Address | Philadelphia, PA 19130-3002 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/10/2012 |
Last Update Date | 30/07/2021 |