Provider Demographics
NPI:1417205592
Name:RUTH, HEATHER C
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:C
Last Name:RUTH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4115 CONRAD RD
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22312-1155
Mailing Address - Country:US
Mailing Address - Phone:301-792-0601
Mailing Address - Fax:
Practice Address - Street 1:4141 N HENDERSON RD
Practice Address - Street 2:PLAZA 8
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22203-2486
Practice Address - Country:US
Practice Address - Phone:301-792-0601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-21
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0121000284171100000X
MDU01242171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist