Provider Demographics
NPI:1588832505
Name:PARDUE, RUTH (PT)
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:
Last Name:PARDUE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:RUTH
Other - Middle Name:MCLEOD
Other - Last Name:PARDUE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:1225 MACARTHUR BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577-3902
Mailing Address - Country:US
Mailing Address - Phone:510-895-1392
Mailing Address - Fax:
Practice Address - Street 1:2100 ORCHARD AVE
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-3415
Practice Address - Country:US
Practice Address - Phone:510-399-1563
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-12
Last Update Date:2023-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27894225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist