Provider Demographics
NPI:1497724975
Name:CARRUTHERS, JACK (PT)
Entity Type:Individual
Prefix:
First Name:JACK
Middle Name:
Last Name:CARRUTHERS
Suffix:
Gender:M
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:PO BOX 6062
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44312-0062
Mailing Address - Country:US
Mailing Address - Phone:330-630-1860
Mailing Address - Fax:330-630-3198
Practice Address - Street 1:161 NORTHWEST AVE
Practice Address - Street 2:STE. 104
Practice Address - City:TALLMADGE
Practice Address - State:OH
Practice Address - Zip Code:44278-1850
Practice Address - Country:US
Practice Address - Phone:330-630-1860
Practice Address - Fax:330-630-1860
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH05088225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist