Provider Demographics
NPI:1013589654
Name:RUTAR, MICHAEL
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:RUTAR
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1951 W CAMELBACK RD STE 450
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85015-3474
Mailing Address - Country:US
Mailing Address - Phone:320-267-8360
Mailing Address - Fax:
Practice Address - Street 1:1951 W CAMELBACK RD STE 450
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-3474
Practice Address - Country:US
Practice Address - Phone:320-267-8360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-13
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTH-008107225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZOTH-008107OtherARIZONA BOARD OF OCCUPATIONAL THERAPY EXAMINERS
424259OtherTHE NATIONAL BOARD FOR CERTIFICATION IN OCCUPATIONAL THERAPY