Provider Demographics
NPI:1497996250
Name:RUTHERFORD, CRISHEILA MANGABAT (RPT)
Entity Type:Individual
Prefix:MRS
First Name:CRISHEILA
Middle Name:MANGABAT
Last Name:RUTHERFORD
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:21323 MAYALL ST
Mailing Address - Street 2:
Mailing Address - City:CHATSWORTH
Mailing Address - State:CA
Mailing Address - Zip Code:91311-3024
Mailing Address - Country:US
Mailing Address - Phone:818-304-1314
Mailing Address - Fax:818-914-0509
Practice Address - Street 1:21323 MAYALL ST
Practice Address - Street 2:
Practice Address - City:CHATSWORTH
Practice Address - State:CA
Practice Address - Zip Code:91311-3024
Practice Address - Country:US
Practice Address - Phone:818-304-1314
Practice Address - Fax:818-914-0509
Is Sole Proprietor?:No
Enumeration Date:2009-03-09
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32887225100000X, 2251E1300X, 2251G0304X, 2251N0400X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251E1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistElectrophysiology, Clinical
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
No2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic