Provider Demographics
NPI:1689198871
Name:RUTERBUSCH, CHANDLER P (DPT)
Entity Type:Individual
Prefix:DR
First Name:CHANDLER
Middle Name:P
Last Name:RUTERBUSCH
Suffix:
Gender:M
Credentials:DPT
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 370
Mailing Address - Street 2:
Mailing Address - City:FORTSON
Mailing Address - State:GA
Mailing Address - Zip Code:31808-0370
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:706-494-3008
Practice Address - Street 1:3627 UNIVERSITY BLVD S STE 550
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-7401
Practice Address - Country:US
Practice Address - Phone:904-570-8604
Practice Address - Fax:904-458-4819
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-28
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT015096225100000X
FLPT32618225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty