Provider Demographics
NPI:1942466289
Name:BURD, RUTH ADELE (PT)
Entity Type:Individual
Prefix:MS
First Name:RUTH
Middle Name:ADELE
Last Name:BURD
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:PO BOX 2267
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87504-2267
Mailing Address - Country:US
Mailing Address - Phone:505-327-7720
Mailing Address - Fax:505-325-2477
Practice Address - Street 1:608 REILLY AVE
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-2634
Practice Address - Country:US
Practice Address - Phone:505-327-7720
Practice Address - Fax:505-325-2477
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-06
Last Update Date:2011-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2561225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist