Provider Demographics
NPI:1730669599
Name:PFUELLER, RUTHIE A (PTA)
Entity Type:Individual
Prefix:MRS
First Name:RUTHIE
Middle Name:A
Last Name:PFUELLER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:745 W 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:CORSICANA
Mailing Address - State:TX
Mailing Address - Zip Code:75110-4563
Mailing Address - Country:US
Mailing Address - Phone:903-641-5787
Mailing Address - Fax:
Practice Address - Street 1:2302 S OAK GROVE RD
Practice Address - Street 2:
Practice Address - City:ENNIS
Practice Address - State:TX
Practice Address - Zip Code:75119-6841
Practice Address - Country:US
Practice Address - Phone:972-875-8641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-20
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2028082208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation