Provider Demographics
NPI:1609886944
Name:GAUTHIER, RUTH E (PT)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:E
Last Name:GAUTHIER
Suffix:
Gender:F
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 1119
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02901-1119
Mailing Address - Country:US
Mailing Address - Phone:401-849-5596
Mailing Address - Fax:
Practice Address - Street 1:345 VALLEY RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:RI
Practice Address - Zip Code:02842-5236
Practice Address - Country:US
Practice Address - Phone:401-849-5596
Practice Address - Fax:401-847-9136
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI00655174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI007006789Medicare ID - Type Unspecified