Provider Demographics
NPI:1578952826
Name:HARRIS, RUTH
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 JOANNE DR
Mailing Address - Street 2:
Mailing Address - City:SEAFORD
Mailing Address - State:VA
Mailing Address - Zip Code:23696-2448
Mailing Address - Country:US
Mailing Address - Phone:757-234-4481
Mailing Address - Fax:
Practice Address - Street 1:111 JOANNE DR
Practice Address - Street 2:
Practice Address - City:SEAFORD
Practice Address - State:VA
Practice Address - Zip Code:23696-2448
Practice Address - Country:US
Practice Address - Phone:757-234-4481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-09
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306602961225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant