Provider Demographics
NPI:1023297611
Name:RUETH, MARY KAYE (DPT)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:KAYE
Last Name:RUETH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8805 TAMIAMI TRL N
Mailing Address - Street 2:211
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34108-2525
Mailing Address - Country:US
Mailing Address - Phone:239-431-7396
Mailing Address - Fax:866-357-4717
Practice Address - Street 1:840 111TH AVE N
Practice Address - Street 2:STE 1
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34108-1877
Practice Address - Country:US
Practice Address - Phone:239-431-7396
Practice Address - Fax:866-357-4717
Is Sole Proprietor?:No
Enumeration Date:2007-10-30
Last Update Date:2016-02-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL23764225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAH194YMedicare PIN