Provider Demographics
NPI:1467117507
Name:RUFFNER, CAROLYN CAMILLE (PT)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:CAMILLE
Last Name:RUFFNER
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 1:4421 HAMMOCKS DR
Mailing Address - Street 2:
Mailing Address - City:GENESEO
Mailing Address - State:NY
Mailing Address - Zip Code:14454-9630
Mailing Address - Country:US
Mailing Address - Phone:716-378-0689
Mailing Address - Fax:585-229-8687
Practice Address - Street 1:5132 RTE 63
Practice Address - Street 2:
Practice Address - City:GENESEO
Practice Address - State:NY
Practice Address - Zip Code:14454-1445
Practice Address - Country:US
Practice Address - Phone:716-378-0689
Practice Address - Fax:585-229-8687
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-03
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011704-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist