Individual
RONALD RUTTEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
300 S 3RD W, SODA SPRINGS, ID 83276-1559
(208) 547-3341
(208) 547-2790
Mailing address
1872 N HONEYSUCKLE LN, INKOM, ID 83245-1612
(208) 775-3531
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT-433
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PT-433
BUREAU OF OCCUPATIONAL LICENSES
ID
Enumeration date
11/11/2015
Last updated
11/11/2015
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