Basic Information
Provider Information
NPI: 1811940273
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WERNER
FirstName: RUTH
MiddleName: A
NamePrefix: MS.
NameSuffix:  
Credential: BSPT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 241686
Address2:  
City: MONTGOMERY
State: AL
PostalCode: 361241686
CountryCode: US
TelephoneNumber: 3343962110
FaxNumber: 3343962115
Practice Location
Address1: 825 W WASHINGTON ST
Address2:  
City: EUFAULA
State: AL
PostalCode: 360271847
CountryCode: US
TelephoneNumber: 3346887155
FaxNumber: 3346167615
Other Information
ProviderEnumerationDate: 05/18/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: X
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000XPTH827ALY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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