Provider Demographics
NPI:1942724133
Name:RUTHERFORD, KATHRYN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:RUTHERFORD
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:722 HENDERSON RD
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08048-4611
Mailing Address - Country:US
Mailing Address - Phone:609-367-2002
Mailing Address - Fax:
Practice Address - Street 1:15736 W MADISON ST
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-6468
Practice Address - Country:US
Practice Address - Phone:609-367-2002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-28
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPT-30882225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist