Provider Demographics
NPI:1124003223
Name:RUFF, PHILLIP A (MPT, CHT)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:A
Last Name:RUFF
Suffix:
Gender:M
Credentials:MPT, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 NE MOTHER JOSEPH PL
Mailing Address - Street 2:SUITE 210
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98664-3299
Mailing Address - Country:US
Mailing Address - Phone:360-254-6161
Mailing Address - Fax:360-449-1139
Practice Address - Street 1:200 NE MOTHER JOSEPH PL
Practice Address - Street 2:SUITE 110
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98664-3299
Practice Address - Country:US
Practice Address - Phone:360-254-6161
Practice Address - Fax:360-449-1139
Is Sole Proprietor?:No
Enumeration Date:2005-12-12
Last Update Date:2009-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR30392251H1200X
WAPT000077432251H1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251H1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR098565018OtherBCBS OF OR
WA8434649Medicaid
OR295474Medicaid
WA173399OtherWA L&I
WA8853390Medicare ID - Type Unspecified
OR116308Medicare ID - Type Unspecified