Individual
MR. H. RUFFIN WALDEN III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
1301 S KOKE MILL RD, SPRINGFIELD, IL 62711-9252
(217) 547-9100
(217) 547-9247
Mailing address
PO BOX 9469, SPRINGFIELD, IL 62791-9469
(217) 547-9100
(217) 547-9247
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
070-001474
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
916500
MEDICARE ID #
IL
01
—
P00769841
RAILROAD MEDICARE
IL
Enumeration date
07/19/2007
Last updated
12/30/2009
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