Provider Demographics
NPI:1710022405
Name:WAGNER, RUTH SUNSHINE (DPT)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:SUNSHINE
Last Name:WAGNER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:STURBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:01566-1283
Mailing Address - Country:US
Mailing Address - Phone:508-347-7550
Mailing Address - Fax:508-347-7559
Practice Address - Street 1:57 MAIN ST
Practice Address - Street 2:
Practice Address - City:STURBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:01566-1283
Practice Address - Country:US
Practice Address - Phone:508-347-7550
Practice Address - Fax:508-347-7559
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA17757225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist