Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 2305207257 | VA |
N | 2251N0400X | Physical Therapist - Neurology | 2305207257 | VA |
NPI | 1578836557 |
---|---|
Provider Name | Elizabeth Audrey Ruckert |
First Address | Arlington, VA 22201-4763 |
Second Address | Alexandria, VA 22304-2926 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2012 |
Last Update Date | 21/02/2012 |