Provider Demographics
NPI:1063105203
Name:RUTHERFORD, MARY (PT, DPT)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:RUTHERFORD
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:935 E 4TH ST
Mailing Address - Street 2:
Mailing Address - City:JUNCTION CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66441-2867
Mailing Address - Country:US
Mailing Address - Phone:785-579-6790
Mailing Address - Fax:785-579-6792
Practice Address - Street 1:935 E 4TH ST
Practice Address - Street 2:
Practice Address - City:JUNCTION CITY
Practice Address - State:KS
Practice Address - Zip Code:66441-2867
Practice Address - Country:US
Practice Address - Phone:785-579-6790
Practice Address - Fax:785-579-6792
Is Sole Proprietor?:No
Enumeration Date:2023-06-01
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-07337225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist