Provider Demographics
NPI:1447417845
Name:EDLIN, RUTH ELLEN (LMT)
Entity Type:Individual
Prefix:MRS
First Name:RUTH
Middle Name:ELLEN
Last Name:EDLIN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:120 HELMWOOD PLAZA DRIVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-2479
Mailing Address - Country:US
Mailing Address - Phone:270-765-5631
Mailing Address - Fax:270-737-6229
Practice Address - Street 1:120 HELMWOOD PLAZA DR
Practice Address - Street 2:SUITE 103
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-2479
Practice Address - Country:US
Practice Address - Phone:270-765-5631
Practice Address - Fax:270-737-6229
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-22
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2300225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist