Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 40QA00388000 | NJ |
NPI | 1023471505 |
---|---|
Provider Name | Mrs. Sarah Ruitenberg |
First Address | Ramsey, NJ 07446 |
Second Address | Pompton Plains, NJ 07444-2100 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/04/2016 |
Last Update Date | 05/04/2016 |