Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 5502000898 | MI |
NPI | 1013418771 |
---|---|
Provider Name | Melanie Sue Ruddy |
First Address | New Lothrop, MI 48460-0446 |
Second Address | Saginaw, MI 48604-9413 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2018 |
Last Update Date | 27/02/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5502000898 | (05) | MI |