Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | IN | |
Y | 225100000X | Physical Therapist | 5501016729 | MI |
NPI | 1003199464 |
---|---|
Provider Name | Jana C Ruddy |
First Address | Monroe, MI 48162 |
Second Address | Monroe, MI 48162 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2011 |
Last Update Date | 12/07/2018 |