Provider Demographics
NPI:1790959658
Name:RUTTENBERG, JON J (LPT)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:J
Last Name:RUTTENBERG
Suffix:
Gender:M
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8415 BELLONA LN
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21204-2055
Mailing Address - Country:US
Mailing Address - Phone:410-821-7775
Mailing Address - Fax:410-821-1320
Practice Address - Street 1:8415 BELLONA LN
Practice Address - Street 2:SUITE 201
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21204-2055
Practice Address - Country:US
Practice Address - Phone:410-821-7775
Practice Address - Fax:410-821-1320
Is Sole Proprietor?:No
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD19917225100000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD19917OtherPHYSICAL THERAPIST