Provider Demographics
NPI:1801415351
Name:CARRUTH, DEWIGHT
Entity Type:Individual
Prefix:
First Name:DEWIGHT
Middle Name:
Last Name:CARRUTH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1624 LEXINGTON CIR
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-5700
Mailing Address - Country:US
Mailing Address - Phone:706-536-7664
Mailing Address - Fax:
Practice Address - Street 1:1624 LEXINGTON CIR
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-5700
Practice Address - Country:US
Practice Address - Phone:706-536-7664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-14
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes226300000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersKinesiotherapist