Provider Demographics
NPI:1861449183
Name:RUTLEDGE, BRENDA (PT)
Entity Type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:
Last Name:RUTLEDGE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:BRENDA
Other - Middle Name:
Other - Last Name:CAVANAUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:5236 TALBOTS LANDING
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043
Mailing Address - Country:US
Mailing Address - Phone:443-445-3733
Mailing Address - Fax:
Practice Address - Street 1:5236 TALBOTS LNDG
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-6845
Practice Address - Country:US
Practice Address - Phone:443-445-3733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-30
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD19648225100000X
MD225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist