Provider Demographics
NPI:1194941476
Name:RUTTIGER, CORINNE (AT,C)
Entity type:Individual
Prefix:
First Name:CORINNE
Middle Name:
Last Name:RUTTIGER
Suffix:
Gender:F
Credentials:AT,C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6436 NW 170TH TER
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-4600
Mailing Address - Country:US
Mailing Address - Phone:305-823-5044
Mailing Address - Fax:
Practice Address - Street 1:18350 NW 67TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-3403
Practice Address - Country:US
Practice Address - Phone:305-557-3770
Practice Address - Fax:305-827-8896
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL 3942255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer