Provider Demographics
NPI:1427442524
Name:RUTHERFORD, BIFF (PTA)
Entity type:Individual
Prefix:
First Name:BIFF
Middle Name:
Last Name:RUTHERFORD
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 E OAK ST
Mailing Address - Street 2:
Mailing Address - City:MC RAE
Mailing Address - State:GA
Mailing Address - Zip Code:31055-4347
Mailing Address - Country:US
Mailing Address - Phone:229-860-0314
Mailing Address - Fax:
Practice Address - Street 1:520 E OAK ST
Practice Address - Street 2:
Practice Address - City:MC RAE
Practice Address - State:GA
Practice Address - Zip Code:31055-4347
Practice Address - Country:US
Practice Address - Phone:229-860-0314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-26
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPTA003185225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant