Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251E1200X | Ergonomics | 3189 | AZ |
N | 225XE1200X | Ergonomics | 3189 | AZ |
N | 2251G0304X | Physical Therapist - Geriatrics | 3189 | AZ |
N | 2251X0800X | Physical Therapist - Orthopedic | 3189 | AZ |
NPI | 1811946502 |
---|---|
Provider Name | Ruth S Backway |
First Address | Prescott, AZ 86303-4714 |
Second Address | Prescott, AZ 86303-4714 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0187238 | STATE OF WASHINGTON DOL (01) | WA |
642901 | (05) | AZ |
AZ 0462680 | BCBS (01) | AZ |
S65510 | (02) |