Provider Demographics
NPI:1376711101
Name:RUTHERFORD, JANET A (PT)
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:A
Last Name:RUTHERFORD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2418 BENNINGTON LN
Mailing Address - Street 2:
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050-9008
Mailing Address - Country:US
Mailing Address - Phone:815-344-1849
Mailing Address - Fax:
Practice Address - Street 1:820 E TERRA COTTA AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-3649
Practice Address - Country:US
Practice Address - Phone:815-455-3262
Practice Address - Fax:815-455-2729
Is Sole Proprietor?:No
Enumeration Date:2008-02-14
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist