Provider Demographics
NPI:1891915740
Name:CARRUTH, CAMBRIDGE (PT)
Entity Type:Individual
Prefix:
First Name:CAMBRIDGE
Middle Name:
Last Name:CARRUTH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 N RICHARD JACKSON BLVD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:PANAMA CITY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32407-2521
Mailing Address - Country:US
Mailing Address - Phone:850-235-6360
Mailing Address - Fax:850-235-8871
Practice Address - Street 1:120 R JACKSON BVLD.
Practice Address - Street 2:STE. 130
Practice Address - City:PANAMA CITY BEACH
Practice Address - State:FL
Practice Address - Zip Code:32407
Practice Address - Country:US
Practice Address - Phone:850-235-6360
Practice Address - Fax:850-235-8871
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2013-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL25627225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist