Provider Demographics
NPI:1316188782
Name:LARSEN, RUTHANN (PT)
Entity Type:Individual
Prefix:
First Name:RUTHANN
Middle Name:
Last Name:LARSEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:RUTHANN
Other - Middle Name:
Other - Last Name:QUICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:14557 W INDIAN SCHOOL ROAD
Mailing Address - Street 2:500B
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395
Mailing Address - Country:US
Mailing Address - Phone:623-242-6908
Mailing Address - Fax:623-242-6909
Practice Address - Street 1:14557 W INDIAN SCHOOL ROAD
Practice Address - Street 2:500B
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395
Practice Address - Country:US
Practice Address - Phone:623-242-6908
Practice Address - Fax:623-242-6909
Is Sole Proprietor?:No
Enumeration Date:2009-03-16
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPT-013715225100000X
AZAZ2561225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist