Provider Demographics
NPI:1942496732
Name:RUTLEDGE, THERESE MARIE (PT, LSW, GCS)
Entity Type:Individual
Prefix:
First Name:THERESE
Middle Name:MARIE
Last Name:RUTLEDGE
Suffix:
Gender:F
Credentials:PT, LSW, GCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6812 KAREN DR
Mailing Address - Street 2:
Mailing Address - City:SEVEN HILLS
Mailing Address - State:OH
Mailing Address - Zip Code:44131-3713
Mailing Address - Country:US
Mailing Address - Phone:216-642-1089
Mailing Address - Fax:
Practice Address - Street 1:6812 KAREN DR
Practice Address - Street 2:
Practice Address - City:SEVEN HILLS
Practice Address - State:OH
Practice Address - Zip Code:44131-3713
Practice Address - Country:US
Practice Address - Phone:216-642-1089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-14
Last Update Date:2007-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS 19585104100000X
OHPT 8310225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No104100000XBehavioral Health & Social Service ProvidersSocial Worker