Provider Demographics
NPI:1790097244
Name:RUHL, EDWARD (LMT)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:RUHL
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4498 MONGITE RD
Mailing Address - Street 2:
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34287-2821
Mailing Address - Country:US
Mailing Address - Phone:941-426-9740
Mailing Address - Fax:941-426-9740
Practice Address - Street 1:4498 MONGITE RD
Practice Address - Street 2:
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34287-2821
Practice Address - Country:US
Practice Address - Phone:941-426-9740
Practice Address - Fax:941-426-9740
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-12
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA42560225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist