Provider Demographics
NPI:1740304641
Name:BURNS, RUTH ANN FEDOR (DPT)
Entity type:Individual
Prefix:MRS
First Name:RUTH ANN
Middle Name:FEDOR
Last Name:BURNS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 VERONICA LN
Mailing Address - Street 2:
Mailing Address - City:CHARLES TOWN
Mailing Address - State:WV
Mailing Address - Zip Code:25414-4150
Mailing Address - Country:US
Mailing Address - Phone:540-539-7420
Mailing Address - Fax:
Practice Address - Street 1:80 MADDEX DR
Practice Address - Street 2:
Practice Address - City:SHEPHERDSTOWN
Practice Address - State:WV
Practice Address - Zip Code:25443-4305
Practice Address - Country:US
Practice Address - Phone:304-876-9422
Practice Address - Fax:304-876-6869
Is Sole Proprietor?:No
Enumeration Date:2007-03-17
Last Update Date:2017-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV002132225100000X
VA2305202943225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV002132OtherWV PT LICENSE
N 252291218-8OtherHPSO LIABILITY INSURANCE
VA2305202943OtherVA PT LICENSE