Provider Demographics
NPI:1275652091
Name:RUTLEDGE, CARRIE R (PT)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:R
Last Name:RUTLEDGE
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 1:2960 ELDORADO PKWY
Mailing Address - Street 2:SUITE 75
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-4373
Mailing Address - Country:US
Mailing Address - Phone:972-562-0713
Mailing Address - Fax:972-562-0932
Practice Address - Street 1:2960 ELDORADO PKWY
Practice Address - Street 2:SUITE 75
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-4373
Practice Address - Country:US
Practice Address - Phone:972-562-0713
Practice Address - Fax:972-562-0932
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1130714225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX201894701Medicaid
TX8T9272OtherBCBS
TX813T84OtherBCBS
TX8T9272OtherBCBS
TX201894701Medicaid