Basic Information
| Provider Information | |||||||||
| NPI: | 1366700403 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ALLEN | ||||||||
| FirstName: | RUTH | ||||||||
| MiddleName: | ELLEN | ||||||||
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| Credential: | COTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 720 209TH AVENUE CT E | ||||||||
| Address2: | |||||||||
| City: | LAKE TAPPS | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983915602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2538624795 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2323 JENSEN ST | ||||||||
| Address2: | |||||||||
| City: | ENUMCLAW | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980223605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3608252541 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2012 | ||||||||
| LastUpdateDate: | 04/26/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2000X | OC 60231228 | WA | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
No ID Information.