Provider Demographics
NPI:1801011150
Name:NANNI, RUTH M (PTA)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:M
Last Name:NANNI
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:PO BOX 17400
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32522-7400
Mailing Address - Country:US
Mailing Address - Phone:850-494-4400
Mailing Address - Fax:850-494-4993
Practice Address - Street 1:2120 E JOHNSON AVE
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-6028
Practice Address - Country:US
Practice Address - Phone:850-494-4400
Practice Address - Fax:850-494-4993
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA19890225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2022614OtherTEXAS PTA LICENSE
FLPTA19890OtherMEDICAL LICENSE
FLNPP000Medicare UPIN