Provider Demographics
NPI:1306175161
Name:RUFTY, JOHN LUTHER JR (CPO)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:LUTHER
Last Name:RUFTY
Suffix:JR
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1152
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:NC
Mailing Address - Zip Code:28658-1152
Mailing Address - Country:US
Mailing Address - Phone:828-441-2011
Mailing Address - Fax:828-441-2012
Practice Address - Street 1:2760 TATE BLVD SE
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-1448
Practice Address - Country:US
Practice Address - Phone:828-441-2011
Practice Address - Fax:828-441-2012
Is Sole Proprietor?:No
Enumeration Date:2009-12-08
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCCPO02352225000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7795169Medicaid