Provider Demographics
NPI:1356015788
Name:FLORES, RUTH V (LMT)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:V
Last Name:FLORES
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8238 WHITE PINE DR
Mailing Address - Street 2:
Mailing Address - City:MANASSAS PARK
Mailing Address - State:VA
Mailing Address - Zip Code:20111-2309
Mailing Address - Country:US
Mailing Address - Phone:571-361-6706
Mailing Address - Fax:
Practice Address - Street 1:8238 WHITE PINE DR
Practice Address - Street 2:
Practice Address - City:MANASSAS PARK
Practice Address - State:VA
Practice Address - Zip Code:20111-2309
Practice Address - Country:US
Practice Address - Phone:571-361-6706
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-09
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019015903225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist