Provider Demographics
NPI:1215377601
Name:RUTENBERG, DMITRY (DPT)
Entity type:Individual
Prefix:
First Name:DMITRY
Middle Name:
Last Name:RUTENBERG
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4611 N FEDERAL HWY APT 525
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33064-6686
Mailing Address - Country:US
Mailing Address - Phone:917-642-8865
Mailing Address - Fax:
Practice Address - Street 1:4611 N FEDERAL HWY APT 525
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33064-6686
Practice Address - Country:US
Practice Address - Phone:917-642-8865
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-28
Last Update Date:2020-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist