Provider Demographics
NPI:1700880473
Name:AUBREY, RUTH N (PT)
Entity Type:Individual
Prefix:MRS
First Name:RUTH
Middle Name:N
Last Name:AUBREY
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 1:6475 VAN BUREN ST
Mailing Address - Street 2:STE 102
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526-7571
Mailing Address - Country:US
Mailing Address - Phone:251-626-9052
Mailing Address - Fax:251-626-5384
Practice Address - Street 1:6475 VAN BUREN ST
Practice Address - Street 2:STE 102
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36526-7571
Practice Address - Country:US
Practice Address - Phone:251-626-9052
Practice Address - Fax:251-626-5384
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH847174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL130287Medicaid
AL630997518OtherCOMMERCIAL ID
AL130288Medicaid
AL18371OtherHEALTHSPRING ID
AL51072218OtherBLUE CROSS
AL509115OtherAETNA I.D.
ALR75614Medicare UPIN
AL000072218Medicare ID - Type UnspecifiedMEDICARE NUMBER