Provider Demographics
NPI:1962722900
Name:RUTHERFORD, CHRISTIE R (PT)
Entity type:Individual
Prefix:MRS
First Name:CHRISTIE
Middle Name:R
Last Name:RUTHERFORD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:234 MEADOWBROOK RD
Mailing Address - Street 2:
Mailing Address - City:WYCKOFF
Mailing Address - State:NJ
Mailing Address - Zip Code:07481-3436
Mailing Address - Country:US
Mailing Address - Phone:201-848-9576
Mailing Address - Fax:201-857-3802
Practice Address - Street 1:234 MEADOWBROOK RD
Practice Address - Street 2:
Practice Address - City:WYCKOFF
Practice Address - State:NJ
Practice Address - Zip Code:07481-3436
Practice Address - Country:US
Practice Address - Phone:201-848-9576
Practice Address - Fax:201-857-3802
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-01
Last Update Date:2010-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA001701002251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics