Provider Demographics
NPI:1497304505
Name:RUTA, MCKENNA (DPT)
Entity Type:Individual
Prefix:
First Name:MCKENNA
Middle Name:
Last Name:RUTA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MCKENNA
Other - Middle Name:
Other - Last Name:OSTRYNIEC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 306393
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37230-6393
Mailing Address - Country:US
Mailing Address - Phone:615-373-1350
Mailing Address - Fax:615-373-7116
Practice Address - Street 1:1919 CHARLOTTE AVE STE 220
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-2245
Practice Address - Country:US
Practice Address - Phone:615-656-0530
Practice Address - Fax:615-656-0531
Is Sole Proprietor?:No
Enumeration Date:2019-09-11
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN225100000X
TN13766225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist