Provider Demographics
NPI:1083657225
Name:NAYLOR, RUTH B (PT)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:B
Last Name:NAYLOR
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18701 MAPLECROFT LAKE LN
Mailing Address - Street 2:
Mailing Address - City:DAVIDSON
Mailing Address - State:NC
Mailing Address - Zip Code:28036-8830
Mailing Address - Country:US
Mailing Address - Phone:704-892-0179
Mailing Address - Fax:
Practice Address - Street 1:503 CANVASBACK RD
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-8134
Practice Address - Country:US
Practice Address - Phone:704-799-9791
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5291225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC95619OtherMEDCOST
NC7210609Medicaid
NC07928OtherBCBS
NC7513136OtherAETNA