Provider Demographics
NPI:1104178680
Name:RUTTER, PHILIP A (PHD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:A
Last Name:RUTTER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 GRANDVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:PITMAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08071-1608
Mailing Address - Country:US
Mailing Address - Phone:267-975-9184
Mailing Address - Fax:
Practice Address - Street 1:2401 PENNSYLVANIA AVE
Practice Address - Street 2:STE 1A2
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19130-3002
Practice Address - Country:US
Practice Address - Phone:267-975-9184
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-09
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS-009007-L103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling