Provider Demographics
NPI:1780930313
Name:RUTH, PAUL ALAN
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:ALAN
Last Name:RUTH
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 1:7802 E GRAY RD.
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260
Mailing Address - Country:US
Mailing Address - Phone:480-225-8518
Mailing Address - Fax:480-295-7635
Practice Address - Street 1:7802 E GRAY RD
Practice Address - Street 2:STE 300
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-2964
Practice Address - Country:US
Practice Address - Phone:480-922-4499
Practice Address - Fax:480-295-7635
Is Sole Proprietor?:No
Enumeration Date:2012-08-01
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-05077P225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist