Provider Demographics
NPI:1336766435
Name:RUTLEDGE, MONTAY
Entity Type:Individual
Prefix:
First Name:MONTAY
Middle Name:
Last Name:RUTLEDGE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17100 BOCA CLUB BLVD APT 1
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33487-1256
Mailing Address - Country:US
Mailing Address - Phone:561-419-3369
Mailing Address - Fax:
Practice Address - Street 1:17100 BOCA CLUB BLVD APT 1
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33487-1256
Practice Address - Country:US
Practice Address - Phone:561-419-3369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-06
Last Update Date:2020-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program