Individual
GRANT RUTLEDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT, DPT
Contact information
Practice address
2805 S 88TH ST, SUITE 102, OMAHA, NE 68124-3064
(402) 393-9390
(402) 393-9388
Mailing address
2805 S 88TH ST, SUITE 102, OMAHA, NE 68124-3064
(402) 393-9390
(402) 393-9388
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
3366
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
470821137
—
NE
05
—
ZZ225100000X
—
IA
Enumeration date
07/31/2014
Last updated
07/31/2014
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