Provider Demographics
NPI:1013919430
Name:JONGBLOETS, RUTGERUS FRANCISCUS (PT)
Entity Type:Individual
Prefix:
First Name:RUTGERUS
Middle Name:FRANCISCUS
Last Name:JONGBLOETS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 CORPORATE DR STE 400
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35242-5424
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:
Practice Address - Street 1:18641 HIGHWAY 3235
Practice Address - Street 2:
Practice Address - City:GALLIANO
Practice Address - State:LA
Practice Address - Zip Code:70354-3936
Practice Address - Country:US
Practice Address - Phone:985-475-4555
Practice Address - Fax:985-475-4557
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA01567F225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA346732YUZ5OtherMEDICARE PTAN
LA346732YWWBOtherMEDICARE PTAN
766387OtherOPTUM