Provider Demographics
NPI:1033482591
Name:RUTHERFORD, MICHELLE M (DPT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:M
Last Name:RUTHERFORD
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:M
Other - Last Name:STEPHENSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:534 E PINE ST STE A
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95204-5536
Mailing Address - Country:US
Mailing Address - Phone:209-463-5800
Mailing Address - Fax:209-463-5900
Practice Address - Street 1:10200 TRINITY PKWY STE 205
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95219
Practice Address - Country:US
Practice Address - Phone:209-451-3920
Practice Address - Fax:209-451-3902
Is Sole Proprietor?:No
Enumeration Date:2012-02-14
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT38725225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFV625ZMedicare PIN