Provider Demographics
NPI:1073618310
Name:RUTLEDGE, CRYSTAL (PT)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:RUTLEDGE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:
Other - Last Name:RIMES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 716
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77574-0716
Mailing Address - Country:US
Mailing Address - Phone:832-282-8457
Mailing Address - Fax:
Practice Address - Street 1:17045 EL CAMINO REAL STE 211
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-2644
Practice Address - Country:US
Practice Address - Phone:832-284-4322
Practice Address - Fax:281-715-4232
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11997865225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist